Transient paraplegia in lumbar spine surgery—a potential complication following erector spinae plane block

K. Guna Pratheep, Kartik Sonawane, Shanmuganathan Rajasekaran, Ajoy Prasad Shetty, Balavenkat J Subramanian, Rishi Mugesh Kanna

December 2022, Volume 31, Issue 12, pp 3719 - 3723 Case Report Read Full Article

First Online: 17 November 2021

Purpose

Erector spinae plane block (ESPB) has gained popularity over recent years and is being increasingly used in spine surgery for pain management. To date, no major neurological complications have been reported. We present here two patients who developed transient postoperative paraplegia and discuss the possible causes of this phenomenon.

Methods

Patients, who underwent preoperative bilateral ESPB as an adjunct to general anesthesia for elective lumbar spine surgery at our institution between January 2017 and December 2020, were retrospectively identified. Among them, only patients who developed postoperative motor and sensory deficits were finally included.

Results

Overall, two patients [of 316 who underwent ESPB (0.6%)] developed complete motor and sensory deficits in bilateral lower limbs postoperatively. In both patients, the surgery was uncomplicated. Ninety minutes following recovery from general anesthesia, both patients showed gradual neurological recovery in a distal-to-proximal pattern, with complete motor recovery preceding the sensory improvement. Since the surgical procedure was performed at the cauda equine level, transient paraplegia in these patients could only attributed to ESPB.

Conclusion

Transient paraplegia following ESPB (due to anterior spread of the local anesthetic agent into the epidural space) has never been reported, and both anesthetists and surgeons must be aware of this possible complication.

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