Unexpected transient femoral nerve palsy following epidural catheterization in total hip arthroplasty: A rare case report.

Introduction and importance: Total hip arthroplasty is frequently performed under spinal anesthesia, which is generally safe. However, rare neurological complications, such as femoral nerve palsy, may occur. This report describes an unprecedented case of transient femoral nerve palsy following epidural catheterization in total hip arthroplasty.

Case presentation: A 44-year-old male with femoral head avascular necrosis underwent left total hip arthroplasty. An epidural catheter was placed at the L2/3 level for postoperative pain management without complications. Two days postoperatively, the patient developed right-sided femoral nerve palsy. MRI scans revealed no spinal cord compression or hematoma. The patient's neurological symptoms began to improve five days after surgery and fully resolved by the eighth postoperative day without intervention.

Clinical discussion: Femoral nerve palsy following epidural anesthesia is exceedingly rare and has not been previously documented. Differential diagnoses, including spinal hematoma and nerve compression, were excluded through comprehensive imaging. The transient nature of the palsy suggests a potential mechanical factor related to epidural catheter placement, such as catheter twisting or transient nerve irritation.

Conclusion: This case underscores the importance of promptly evaluating new neurological deficits following epidural anesthesia in total hip arthroplasty patients. Early diagnosis and intervention are crucial to prevent lasting neurological damage, even in the absence of evident spinal lesions. Clinicians should consider mechanical factors related to catheter placement as potential causes of transient nerve palsy.