Epidural Abscess following Multiple Spinal Anaesthetics

A case is presented of a patient who developed back pain following five spinal anaesthetics.The pain was subsequently shown to be due to an epidural abscess which was treated by lumbar laminectomy.Such lesions are rare following spinal anaesthesia.CASE REPORT A 35-year-old, insulin-dependent diabetic man presented for debridement and surgical drainage of an infected foot.Cultures of pus taken from the foot grew staphylococcus aureus and beta-haemolytic streptococcus, sensitive to cloxacillin and penicillin respectively.He was commenced on these two antibiotics, as well as gentamicin, intravenously.Over a period of ten days he received five spinal (subarachnoid) anaesthetics for related procedures, including below-knee amputation of the involved limb.During this period, he had swinging fevers with leucocytosis and poorly controlled blood sugar levels.Coagulation studies were normal, although he received several blood transfusions.Two lumbar punctures were performed at the L3-4 interspace, and three at L4-5, using 25-or 22-gauge spinal needles.Three agents were used: heavy cinchocaine 0.50;0 on three occasions, and bupivacaine plain 0.5% and heavy lignocaine 5% once each.Skin preparation was with standard iodophor solution in every case.Four days after the last spinal anaesthetic, the patient complained of lumbar pain, *M.B., 8.