A 67-Year-Old Man Was Hospitalized Yesterday Following Elective Right Knee

A 67-year-old man was hospitalized yesterday following elective right knee arthroplasty for osteoarthritis.  Medical history is notable for hypertension, type 2 diabetes, and coronary artery disease; the patient is receiving chronic antiplatelet therapy with clopidogrel, which was stopped 5 days prior to surgery.  The procedure was performed under anesthesia via epidural and femoral nerve block, and no intraoperative complications were noted.  Following surgery, patient-controlled analgesia was provided for pain control, and prophylactic enoxaparin was given beginning 12 hours after surgery completion.  Today, the patient has had difficulty urinating after removal of the urinary catheter, as well as low back pain and numbness in the legs.  Examination shows tenderness at the insertion site of the epidural catheter.  The knee incision is clean with no bleeding or drainage.  There is weakness of right plantar flexion and dorsiflexion.  Sensation is decreased in the anterior thigh and leg bilaterally.  Which of the following is the best next step in management of this patient?

A) Compartment pressure measurement
B) Discontinuation of opiate analgesics
C) MRI of the lumbosacral spine
D) Nerve conduction study
E) Reassurance and follow-up

Correct Answer:

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