Paraplegia Following Ultrasound-Guided Caudal Epidural Block in Chronic Lumbosciatica: What Can Be Learned From This Complication?

Caudal epidural block is a procedure that involves the injection of anesthetic agents through the sacral hiatus, commonly used for regional anesthesia. It is also valuable for chronic pain management in lumbosacral conditions, trauma, and palliative care. Ultrasound-guided caudal epidural blocks can be an alternative to fluoroscopy-guided techniques and have demonstrated a notably high success rate. However, despite both techniques being generally regarded as safe, they can lead to severe complications, such as abscesses, epidural hematomas, and subdural punctures. Furthermore, documented instances of lumbosacral region anomalies, stemming from either anatomical variations or underlying pathology, have been associated with an elevated risk of some of these complications. The authors report a rare case of paraplegia following an ultrasound-guided caudal block in a patient with refractory chronic lumbosciatica. This case underscores the need for vigilance in risk assessment and detailed procedural planning. It also highlights the importance of transparent communication, particularly during informed consent, to convey risks and benefits to the patient and their family.