Paraplegia following epidural analgesia

The report of paraplegia following epidural analgesia (Anuesthesiu I98 1; 3 6 952-3) infers an extremely serious allegation about the most significant method of obstetric analgesia currently practised; moreover, thc report is so deficient in obstetric, anaesthetic, neurological, psychiatric and medical details that the diagnosis must be questioned-indeed, if the diagnosis was correct then the case as described is most atypical, for an epidural haematoma constitutes a true emergency in which neurosurgical help must he sought without The details of the case, which are provided are insufficient to conclude that an epidural haematoma caused the neuropathy. The diagnosis could just as easily be an ‘obstetric palsy’3 due to injury of the lumbosacral trunk; yet there is no mention of this not uncommon lesion. The characteristics of obstetric neuropathies3 must he considered before any final diagnosis can he made. An epidural haematoma generally produces a cauda equina syndrome as the references cited in the report clearly indicate; yet the clinical data presented d o not fully support this diagnosis. Blood in the cpidural space and catheter is common. as suggested and, where this is accompanied by evidence of a narrowing of the lumbar spinal canal. a myelogram should he done as a matter of routine as Bromagez points out. The fact that this patient recovered from her paralysis suggests that the neuropathy was not due to haematoma formation. The title of the report is also very misleading. although semantically correct. The term ‘paraplegia’, when used in this context, should be reserved for permanent loss of motor function in the lower part of the body: after all, patients who receive regional or general anaesthesia, all exhibit a ‘ncuropathy’ but such paralysis is rarely, if ever, referred to as a ‘plegia’. Dcpurtment of Anuesihesiu, Royal Women’s Hospital, Grutten Street, Curlton, Vicioriu, Australia 3053 J.A. CROWHUKST