• Yuanling Xiang, Weifeng Wang, Shenfeng Jing, Zhong Zhang, and Dezhang Wang.
• Department of Orthopedics, Zhangqiu People's Hospital, Jinan.
• Medicine (Baltimore). 2021 Jan 22; 100 (3): e24374.

RationaleVocal fold paralysis and cauda equina syndrome are very rare neurologic deficits. This report describes the case of a patient who simultaneously developed both after uneventful spinal-epidural anesthesia with 0.5% hyperbaric bupivacaine.Patient ConcernsWe report the case of a 45-year-old female, who underwent surgery for bilateral hallux valgus developed cauda equina syndrome and unilateral vocal fold paralysis after uneventful spinal-epidural anesthesia was administered. There was no pain or paresthesia during needle placement or drug injection. Surgery was performed uneventfully.DiagnosesRight vocal fold paralysis was diagnosed with flexible laryngoscopy.InterventionsPatient was started on the treatment with a surgery for bilateral hallux valgus, who developed cauda equina syndrome and unilateral vocal fold paralysis after uneventful spinal-epidural anesthesia was administered.OutcomesPostoperatively, she had difficulty in urination and defecation. In addition, she developed unilateral vocal fold paralysis characterized by hoarseness, effortful voice production, and choking with liquids. Magnetic resonance imaging performed on the lumbosacral area and computed tomography of the neck, the chest, and the skull revealed entirely normal results. However, flexible laryngoscopy revealed a right vocal fold paralysis. Although cauda equina syndrome can occur due to neurotoxicity of local anesthetics, the exact etiology of vocal fold paralysis is uncertain.LessonsThe case highlights that 2 rare and serious complications of spinal-epidural anesthesia can even occur in the same patient after uneventful surgery and block performance.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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