Unilateral nerve dysfunction after epidural anesthesia in a patient with a history of substance use: a case report

We present a rare case of unilateral multilevel neurological dysfunction, spanning from mid-thoracic (T6) to sacral (S5), following epidural anesthesia in a patient with a history of substance use scheduled to undergo hemorrhoid surgery. A 35-year-old woman with a history of substance use underwent epidural anesthesia for hemorrhoid surgery. Postoperatively, she experienced left lower limb weakness, urinary and fecal incontinence, sensory loss below the sixth thoracic dermatome, and left perianal numbness. Thoracolumbar magnetic resonance imaging revealed no compressive or ischemic lesions. Her neurological function fully recovered within one month with treatment involving corticosteroids, mannitol, neurotrophic agents, and a structured rehabilitation program. This case highlights that a history of substance use may significantly increase the risk of neurotoxic complications following neuraxial anesthesia. It underscores the necessity of thorough preoperative assessments, immediate imaging to exclude mechanical causes, and the importance of an early, multidisciplinary therapeutic approach that combines pharmacologic neuroprotection and rehabilitation for optimal recovery.