Neurological deficit following lumbar epidural anesthesia with ropivacaine

A 38-year-old woman with placenta previa was scheduled for cesarean section. She had no abnormal medical history including neurological deficit before the operation. Prior to general anesthesia, an epidural catheter was inserted in the L2-3 interspace for postoperative analgesia. There was no difficulty in threading the catheter. No pain, paresthesia or bleeding was elicited at any time. After a test dose of 1% lidocaine 1 ml, a bolus of 0.75% ropivacaine 12 ml was injected through the epidural catheter. At the end of the operation, a continuous epidural infusion of 0.2% ropivacaine (the pump speed of 6 ml x h(-1)) was started. On the second postoperative day, sudden sensory loss level to L2 (right lower extremity), L3 (left one) and flaccid paralysis of bilateral lower extremities occurred. MRI and myelogram showed no abnormality of the spinal cord. Her neurological deficit showed slight improvement but her sensory and motor paralysis still remained. Neurotoxicity of ropivacaine may be the cause of this neurological deficit.