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Thursday, December 18, 2014
My niece had a child last night and had an epidural, last night around 8:00pm. One of her legs is paralyzed. She can feel her foot and her hip, but nothing in between. She cannot stand, she immediately falls when she tries. Is this a long term problem, or will it correct itself?
I hope your niece's leg has recovered. Weakness is a normal feature of epidural anesthesia or analgesia. Sometimes the weakness can take several hours to disappear. The time for recovery depends on the dose and type of local anesthetic used. It may also depend on the site of the epidural catheter - catheters that end up close to a particular nerve root may result in disproportionate weakness or numbness in the distribution of that nerve. Sometimes the distribution seems strange because nerve roots supply sensation to defined areas of the leg. The legs are supplied, in part, by L4 and L5, and the foot by S1.
When the effects of an epidural persists there is always a concern that a nerve has been injured. Such injuries, although uncommon, do occur. In most cases, the effects are transient, and full recovery occurs over a few weeks. Permanent nerve injuries are rare.
It should not be forgotten that although epidurals can result in nerve injury, the majority of nerve injuries in obstetrical patients may be due to birth trauma. That is the effect of the baby's head coming through the birth canal, compressing the lumbar plexus. This type of injury normally heals.
The most feared complication of an epidural is a hematoma (blood clot) in the spinal canal. A hematoma here can compress the spinal cord, decreasing its blood supply, and causing, over the course of 6-8 hours or so, permanent nerve injury. This type of problem often presents with back pain and loss of sensation and movement in both legs. Rapid treatment with surgery will save the spinal cord. I hasten to add that this complication of epidural anesthesia is rare, and can occur spontaneously in people who have not even had an epidural.
Remember that NetWellness is not an emergency service, so if you have immediate concerns about anesthesia-related problems you must consult your doctor. Diagnosis of the cause of weakness or numbness requires a full history, physical examination, and, sometimes, X-Rays, CT or MRI scans, or direct testing of nerves and muscles.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University