An Unusual Cause of Acute Chest Pain During Epidural Anesthesia. Issue 1 (January 1998)

• Record Type: Journal Article
• Authors: Yap, Englok; Dilger, John; Tetzlaff, John E.
• Is Part Of: Regional anesthesia and pain medicine. Volume 23:Issue 1(1998)
• Page Start: 101
• Page End: 103
• Publication Date: 1998-01
• Subjects: regional anesthesia -- epidural anesthesia -- thoracic aortic aneurysm -- epidural physiology -- mepivacaine -- total knee replacement.; Conduction anesthesia -- Periodicals; Pain medicine -- Periodicals; 617.964
• DOI: 10.1136/rapm-00115550-199823010-00019
• Languages: English
• ISSNs: 1098-7339

Abstract

Abstract : Background and Objectives: Selective sympathetic denervation during epidural anesthesia results in a small, active gut. These changes can also result in selective activity in one segment of the gut that is absent in other segments. Case Report: A 61-year-old male was scheduled for bilateral total knee replacement during epidural anesthesia. Following onset of the epidural block, he experienced severe left-sided chest pain. Surgery was canceled. A portable chest radiograph revealed a widened mediastinum, and he underwent angiography to rule out a dissecting thoracic aortic aneurysm. The left subclavian artery could not be visualized, and an MRI was obtained, which was normal. After his return to the intensive care unit, he had a large bowel movement and his chest pain resolved. Conclusion: Selective activity of the gastrointestinal tract during the onset of epidural anesthesia created a visceral pain, which effectively simulated pain with a cardiovascular origin.