A transient neurological blockade after an epidural placement: A case report

Epidural analgesia is widely used in oncological surgery, yet neurological complications are uncommon. We describe a 58-year-old woman with rectal carcinoma who developed sudden, dense, and transient paraplegia immediately after thoracic epidural catheter placement at T10–11, before any epidural drug administration. Local infiltration with 5 mL of 2 % lidocaine preceded the event; within minutes, she exhibited complete bilateral lower-limb paralysis, absent anal tone, and a dense sensory block up to T12. The procedure was atraumatic, and surgery was deferred. Neurological function recovered fully within two hours. The presentation was most consistent with inadvertent intrathecal lidocaine injection during deep infiltration, supported by the proximity of the epidural depth (3.5 cm) to the infiltration needle length (3.8 cm). Lower CSF density in females and possible chemotherapy-related neural sensitivity may have amplified the block. This case underscores the importance of minimal infiltration volumes, careful needle depth control, and vigilance for atypical responses during neuraxial procedures. Understanding baricity-related spread helps anticipate similar transient but alarming neurological events.