{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T04:15:01Z","timestamp":1760242501879,"version":"build-2065373602"},"reference-count":9,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2024,3,24]]},"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>This case report documents a postoperative, incomplete sensorimotor paraparesis from thoracic vertebral body 6 (Th6) after combined anesthesia for upper abdominal surgery in a patient who had a thoracic localization of spinal epidural lipomatosis (SEL).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case presentation<\/jats:title>\n                  <jats:p>The patient was treated in our clinic with a thoracic epidural catheter (TEA) for perioperative analgesia during a partial duodenopancreatectomy. Paraparetic symptoms occurred 20\u2009hours after surgery. Initial MRI did not show bleeding, infection or spinal cord damage and the neurosurgeon consultants recommended observation. The neurological examination and the third follow-up MRI on 15th postoperative day showed ventrolateral damage of the spinal cord at level Th6. It is possible that local anesthetic compressed the spinal cord in addition to the existing lipomatosis and the thoracic kyphosis. The paraparesis improved during follow-up paraplegiologic treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>So far, only two uncomplicated lumbar epidural catheter anesthesias have been described in patients who had a lumbar SEL. Epidural catheter anesthesia is a safe and effective method of pain control. But it is important to carefully identify and stratify patients with risk factors during the premedication visit. In patients who had kyphosis and thoracic localization of SEL, TEA may only be used after a risk\u2013benefit assessment.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2024-105342","type":"journal-article","created":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T13:55:19Z","timestamp":1712325319000},"page":"465-468","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Incomplete sensorimotor paresis after upper abdominal surgery with TEA and spinal epidural lipomatosis: a case report"],"prefix":"10.1136","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3173-3214","authenticated-orcid":false,"given":"Marco Richard","family":"Zugaj","sequence":"first","affiliation":[{"name":"Heidelberg University, Medical Faculty, Department of Anesthesiology, Heidelberg, Baden-W\u00fcrttemberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver","family":"Gutzeit","sequence":"additional","affiliation":[{"name":"Heidelberg University, Medical Faculty, Department of Anesthesiology, Heidelberg, Baden-W\u00fcrttemberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria Louise","family":"Mayer","sequence":"additional","affiliation":[{"name":"Heidelberg University, Medical Faculty, Department of Nuclear Medicine, Heidelberg, Baden-W\u00fcrttemberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Basem","family":"Ishak","sequence":"additional","affiliation":[{"name":"Heidelberg University, Medical Faculty, Department of Neurosurgery, Heidelberg, Baden-W\u00fcrttemberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Gumbinger","sequence":"additional","affiliation":[{"name":"Heidelberg University, Medical Faculty, Department of Neurology, Heidelberg, Baden-W\u00fcrttemberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus Alexander","family":"Weigand","sequence":"additional","affiliation":[{"name":"Heidelberg University, Medical Faculty, Department of Anesthesiology, Heidelberg, Baden-W\u00fcrttemberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens","family":"Ke\u00dfler","sequence":"additional","affiliation":[{"name":"Heidelberg University, Medical Faculty, Department of Anesthesiology, Heidelberg, Baden-W\u00fcrttemberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,4,5]]},"reference":[{"key":"2025101111454463000_49.6.465.1","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1097\/ALN.0000000000002105","article-title":"Prolonged catheter use and infection in regional anesthesia: a retrospective Registry analysis","volume":"128","author":"Bomberg","year":"2018","journal-title":"Anesthesiology"},{"key":"2025101111454463000_49.6.465.2","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aen300"},{"key":"2025101111454463000_49.6.465.3","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1002\/bjs5.50171","article-title":"Meta-analysis of epidural analgesia in patients undergoing Pancreatoduodenectomy","volume":"3","author":"Groen","year":"2019","journal-title":"BJS Open"},{"key":"2025101111454463000_49.6.465.4","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1016\/j.jogc.2018.04.011","article-title":"A case of epidural Lipomatosis in pregnancy: management during labour and Caesarean section","volume":"40","author":"Smith","year":"2018","journal-title":"J Obstet Gynaecol Can"},{"key":"2025101111454463000_49.6.465.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2004.05.252"},{"key":"2025101111454463000_49.6.465.6","doi-asserted-by":"crossref","DOI":"10.52965\/001c.25571","article-title":"Spinal epidural Lipomatosis: a comprehensive review","volume":"13","author":"Walker","year":"2021","journal-title":"Orthop Rev (Pavia)"},{"key":"2025101111454463000_49.6.465.7","article-title":"A case of epidural management in a pregnant patient with spinal epidural Lipomatosis","volume":"11","author":"Ali","year":"2019","journal-title":"Cureus"},{"key":"2025101111454463000_49.6.465.8","doi-asserted-by":"publisher","DOI":"10.1053\/rapm.2002.34323"},{"key":"2025101111454463000_49.6.465.9","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1111\/anae.15391","article-title":"The anaesthesia case report (ACRE) checklist: a tool to promote high-quality reporting of cases in peri-operative practice","volume":"76","author":"Shelton","year":"2021","journal-title":"Anaesthesia"}],"container-title":["Regional Anesthesia &amp; 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