July 15, 1974

Subgluteal Infection Following Regional Anesthesia

Author Affiliations

Pascack Valley Hospital Westwood, NJ

JAMA. 1974;229(3):268. doi:10.1001/jama.1974.03230410014008

To the Editor.—  A 27-year-old woman developed a necrotizing left subgluteal infection with septicemia after an unsuccessful attempt at caudal anesthesia. Recent reports cite the difficulty in diagnosis and the high morbidity and mortality in similar infections.1,2

Report of a Case.—  The patient entered the hospital in normal labor. Several attempts at caudal anesthesia were unsuccessful, requiring an epidural anesthetic. Four hours after delivery of a healthy infant, she experienced severe left buttock pain with radiation into the thigh. The pain worsened and she was readmitted 14 days later. The pain was over the left sacroiliac joint and was severe on deep palpation. The neurological examination showed only a positive straight-leg-raising test on the left. Gynecologic and urologic infections were not present. The sedimentation rate was 44 mm/hr, and a mild leukocytosis was present. The urinalysis gave normal results. A pelvic x-ray examination disclosed no bony lesion or subcutaneous