CAUDA-EQUINA SYNDROME FOLLOWING INTENDED EPIDURAL-ANESTHESIA

Cauda equina syndrome is a rare complication of spinal or epidural anesthesia.1-5 The syndrome results from injury to the sacral nerve roots and is consequently characterized by varying degrees of bladder and bowel dysfunction, perineal sensory loss, and lower extremity motor weakness. One possible etiology of such injury is a direct neurotoxic effect of a local anesthetic. Neurotoxic injury has been reported following the inadvertent intrathecal injection of an intended "epidural dose" of either chloroprocaine6-8 or hexylcaine.5 Recently, we became aware of a case at our institution in which cauda equina syndrome may have resulted from the subarachnoid administration of an intended epidural injection of pH-adjusted 2% lidocaine.