A patient receiving epidural analgesia via infusion develops sudden onset of bilateral lower limb weakness, urinary retention, and back pain 18 hours post-operatively. The most critical diagnosis to rule out, and the time-sensitive intervention, is:

• A Prolonged LA motor block; stop epidural infusion
• B Cauda equina syndrome from saddle block; physiotherapy
• C Epidural abscess; oral antibiotics for 6 weeks
• D Epidural haematoma causing spinal cord compression; urgent MRI and neurosurgical decompression within 6–8 hours of symptom onset ✓

Explanation

New-onset bilateral neurological deficit during or after epidural analgesia is an epidural haematoma or abscess until proven otherwise. Epidural haematoma causes rapid compression of the spinal cord/cauda equina — the neurological outcome is directly related to time from symptom onset to surgical decompression. Decompressive laminectomy within 6–8 hours of onset offers the best chance of neurological recovery; delays beyond 12–24 hours lead to permanent paraplegia. Urgent MRI (not CT) is the imaging of choice. Risk factors include anticoagulant use, coagulopathy, difficult needling, and immunosuppression (for abscess). This is a genuine anaesthetic emergency.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.