A 65-year-old man undergoes prostatectomy in the lithotomy position under spinal anesthesia using bupivacaine 12 mg. Ten hours later, he reports that his left foot is numb. Examination shows decreased pinprick sensation over the lateral dorsal aspect of the left foot; dorsiflexion is limited. Which of the following is the most likely cause?
A 75-year-old man received an uneventful epidural anesthetic for total knee arthroplasty. Twenty-four hours later he has a painless flaccid paralysis in both legs. This clinical presentation is most consistent with
An otherwise healthy 42-year-old woman is referred for management of pain associated with adenocarcinoma of the breast and metastasis to the anterior body of L3. She perceives the pain as moderate and currently takes no pain medication. Her oncologist estimates her life expectancy to be 18 months. The most appropriate initial management is
(A) a benzodiazepine as needed and at bedtime
(B) an oxycodone preparation as needed and a tricyclic antidepressant at bedtime
(C) intravenous patient-controlled analgesia
(D) morphine infusion via an implanted epidural catheter