Question about leg numbess related to epidural or surgery, other postop questions

  1. Warning, this is long! I ask these questions because we never do epidurals for surgery in our facility and I have never seen these posto pcomplications before. Any thoughts you have would be appreciated.
    We have a 65 yr old female that had a right hemicolectomy on 10/11 for colon cancer. She had a continuous epidural placed for surgery consisting of Marcaine and Fentanyl. This ran until 10/14 until DC'd by the CRNA. This pt had a jugular line "attempted" by the surgeon during surgery, then the CRNA or the surgeon placed a right subclavian. The subclavian was leaking at the end of surgery so they DC'd it. Less than 24 hours after surgery the pt was found to have a 90% pneumo on the right. She had a chest tube placed on 10/12 and it was DC'd 10/14.
    So during the epidual postop she had numbness in the right leg from knee to ankle and even now when she stands up her butt and legs feel "heavy".
    There is a lot of weird things surrounding her surgery and her recovery, surgery's charting is incomplete-it does not say anywhere in the chart that a jugular line was ever attempted, I know it was though because she has a mark on her neck and one of the OR nurses told me the surgeon tried. The nurse did not elaborate on why is was not successful. I realize a pneumo can be a general complication of surgery but I was curious to know if anyone thinks it could be from her lines placed/attempted to have been placed. Pt was scheduled to have a MRI study to figure out the leg numbness but she has to wait 6 weeks since the surgery because of the clips in her bowel. Any thoughts in general?
    Jessica
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  2. 4 Comments

  3. by   cmo421
    Most facilities require a chest xray after line placement . I have seen diprovan in the lung,so it really is important. I can not tell u how many pts I have seen post op,with lines and no chest xray.. They waited until they hit the ICU to order them. Real dangerous. A blood return does not mean correct placement. They coil,go up,so many things can happen.Pneumo is a common side effect of line placement. 90% could mean the lung was down for awhile before it was caught.Commonly some respiratory issue would be obvious at this point,but not always!
    The epidural,having had a few and scene hundreds ,also can have many complications. Insertion can be traumatic,causing a host of problems. It is unfortunate,but it happens. Hitting the nerve will cause that heaviness and numbness. Many times it resolves on its own. sometimes not.
  4. by   TooterIA
    They did do a chest xray after placement and placement was ok. Would it have been possible to nick the lung and it wouldnt have shown up in the postop line placement xray?
    She had no Sx of the lung being down, I had her the 1st post op night and pluse ox was 92 % on 2 L, lung sounds clear bilat.
    Jessica
  5. by   cmo421
    Quote from TooterIA
    They did do a chest xray after placement and placement was ok. Would it have been possible to nick the lung and it wouldnt have shown up in the postop line placement xray?
    She had no Sx of the lung being down, I had her the 1st post op night and pluse ox was 92 % on 2 L, lung sounds clear bilat.
    Jessica


    92% on 2l is not great unless she has COPD. Should raise a flag something is wrong,especially with and epidural. Sometimes an xray will not show the lung down right away. IT could also have been a fluke,but doubt that. It happens.If it was nicked and just a very small % was down,they might not see it. Then it gets worse and shows its face somehow.
  6. by   EmmaG
    Quote from TooterIA
    They did do a chest xray after placement and placement was ok. Would it have been possible to nick the lung and it wouldnt have shown up in the postop line placement xray?
    Yep. I had a patient who on the night she'd had a CT-guided needle bx of her liver, developed a spontaneous 100% right pneumo as she sat up to go to the bathroom...in the xray post-procedure, there was no sign of any problems, even though the radiologist charted he suspected the lung had been 'nicked'. The resident I called kept saying "this is SO exciting!!" (the patient looked at him like he was insane LOL)




    As far as the leg numbness and heaviness, that needs to be reported to the anesthesiologist.

    Here's a really good tutorial on epidurals:

    http://www.wisc.edu/trc/projects/pop/Epi-manual.pdf

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