Prolonged Neurological Deficit of Lower Extremity Following Postoperative Continuous Epidural Infusion of 0.2% Ropivacaine

A 45-year-old woman underwent abdominal hysterectomy under spinal anesthesia and epidural anesthesia. She did not feel any abnormal sensation (e.g., paresthesia) during the insertion of the needle and epidural catheter. Four ml of 0.5% isobaric bupivacaine was injected intrathecally followed by epidural administration of 5 ml of 2% mepivacaine. The operation was completed with no complications. Continuous epidural infusion of 0.2% ropivacaine was started at a speed of 4 ml/hr immediately after the operation. The patient was able to stand up with support in the next morning but suddenly developed paralysis in the bilateral lower extremities at night on the same day. Although the paralysis gradually improved after the withdrawal of the epidural injection, muscle weakness in the proximal lower extremities was prolonged. An MRI showed no abnormalities in the spinal cord or spinal column. The patient's symptoms gradually improved over the next 12 months. Twenty-four months after the operation, the patient had recovered from almost all paralysis. Neurotoxicity of 0.2% ropivacaine seemed to be the most probable cause of her neurological deficit, because her symptoms occurred after recovering from spinal anesthesia.