Cauda equina syndrome after spinal anaesthesia with hyperbaric 5% lignocaine: A review of six cases of cauda equina syndrome reported to the Swedish Pharmaceutical Insurance 1993–1997 (original) (raw)
Related papers
Cauda Equina Syndrome After Continuous Spinal Anesthesia
Anesthesia & Analgesia, 1991
Four cases of cauda equina syndrome occurring after continuous spinal anesthesia are reported. In all four cases, there was evidence of a focal sensory block and, to achieve adequate analgesia, a dose of local anesthetic was given that was greater than that usually administered with a singleinjection technique. W e postulate that the combination of maldistribution and a relatively high dose of local anesthetic resulted in neurotoxic injury. Suggestions that may reduce the potential for neurotoxicity are discussed. Use of a lower concentration and a "ceiling" or maximum dose of local anesthetic to establish the block should be considered. If maldistribution of local anesthetic is suspected (as indicated by a focal sensory block), the use of maneuvers to increase the spread of local anesthetic is recommended. If such maneuvers prove unsuccessful, the technique should be abandoned.
Rationale: Neuraxial anesthesia is a commonly used type of regional anesthesia. Cauda equina syndrome is an unusual and severe complication of neuraxial anesthesia, and is caused by damage to the sacral roots of the neural canal. We present a case of cauda equina syndrome following spinal anesthesia in a patient who underwent Bartholin abscess drainage. Patient concerns: A 23-year old female scheduled to undergo surgical drainage of Bartholin abscess. Spinal anesthesia was performed with bupivacaine and fentanyl. There were no perioperative adverse events reported. On postoperative day 1, the patient went to the emergency department describing bilateral weakness and pain of the lower extremities (LE). Diagnoses: Lumbar magnetic resonance imaging showed increased gadolinium accumulation in the neural sheath at the level of the cauda equina tracts, consistent with the diagnosis of arachnoiditis and the diagnosis of cauda equina was established. Interventions: The patient received the following emergent treatment: 75 mg pregabalin (oral) every 12 hours, 20 mg (8 drops) tramadol (oral) every 8 hours, and 4 mg dexamethasone (intravenous) every 6 hours. On postoperative day 4, the patient still experienced bilateral flaccid paraparesis (accentuated in the left side), neuropathic pain in low extremities, and left brachial monoparesis. Hence, dexamethasone was instantly replaced with 1 g methylprednisolone (intravenous) for 5 days. Outcomes: After completing 5 days of methylprednisolone, on postoperative day 9, the patient experienced less pain in left extremities, osteotendinous reflexes were slightly diminished, and she was able to walk with difficulty for 3 to 5 minutes. Greater mobility was evidenced, with right proximal and distal low extremities Medical Research Council Scale grades of 2 and 3 and left proximal and distal low extremities Medical Research Council Scale grades 1 and 2, respectively. Oral prednisone was restarted. Consequently, she was discharged home in stable conditions on postoperative day 25 with a prescription for sertraline, clonazepam, pregabalin, paracetamol, and prednisone. Lesson: The early detection and treatment of complications after neuraxial anesthesia is essential to minimize the risk of permanent damage. Abbreviations: ASA = anesthesiologist physical status, CAT = computerized axial tomography, CES = cauda equina syndrome, CSF = cerebrospinal fluid, EA = epidural anesthesia, GCS = Glasgow Coma Scale, LE = lower extremities, MRC = Medical Research Council, MRI = magnetic resonance imaging, NA = neuraxial anesthesia, OTR = osteotendinous reflexes, PACU = post anesthesia care unit, SA = spinal anesthesia.
Acute cauda equina syndrome following orthopedic procedures as a result of epidural anesthesia
Surgical neurology international, 2018
Cauda equina syndrome (CES) is a rare complication of spinal or epidural anesthesia. It is attributed to direct mechanical injury to the spinal roots of the cauda equina that may result in saddle anesthesia and paraplegia with bowel and bladder dysfunction. The first patient underwent a hip replacement and received 5 mL of 1% lidocaine epidural anesthesia. Postoperatively, when the patient developed an acute CES, the lumbar magnetic resonance imaging (MRI) scan demonstrated clumping/posterior displacement of nerve roots of the cauda equina consistent with adhesive arachnoiditis attributed to the patient's previous L4-L5 lumbar decompression/fusion. The second patient underwent spinal anesthesia (injection of 10 mg of isobaric bupivacaine for an epidural block) for a total knee replacement. When the patient developed an acute CES following surgery, the lumbar MRI scan showed an abnormal T2 signal in the conus and lower thoracic spinal cord over 4.3 cm. Acute CES should be conside...
Continuous microspinal anaesthesia: another perspective on mechanisms inducing cauda equina syndrome
Anaesthesia, 1998
Continuous spinal anaesthesia through a microspinal catheter technique has been criticised on several grounds and is now rarely used. This paper reviews the possible causes of the cauda equina syndrome which have been described and, on the basis of research in cadaver preparations, a glass 'spine' model and clinical experience in over 200 cases, suggests how these problems might be avoided. The use of careful insertion techniques, limiting the length of catheter inserted into the subarachnoid space and the use of no stronger than 0.5% bupivacaine solution are recommended.
Case report: incomplete Cauda Equina Syndrome following a caesarean section with spinal anaesthesia
Italian Journal of Gynaecology and Obstetrics
Background. The Cauda Equina Syndrome is a condition of severe compression or inflammation of the nerves that make up the cauda, that is the anatomical structure consisting of the last spinal roots. Case presentation. On the second day after a caesarean section, a 34-year-old woman at her third pregnancy referred urinary retention, dysesthesia in the buttock and posterior region of the left thigh; constipation on the fifth day. After several clinical examinations, and having excluded the more statistically likely aetiologies, an incomplete Cauda Equina Syndrome was diagnosed, caused by chemical arachnoiditis from a spinal anaesthesia based on hyperbaric bupivacaine. The pathology resolved spontaneously and was not necessary to adopt any therapy other than the minimally invasive one. The urological symptoms were the first to completely disappear, while constipation resolved a few weeks later. Today, only a slight dysesthesia remains in the aforementioned areas. Conclusions. Spinal anaesthesia still proves to be a safe and absolutely practicable method, even if not totally free of serious risks.
Acta Anaesthesiologica Scandinavica, 2001
Lidocaine has been used for spinal anesthesia since 1948, seemingly without causing concern. However, during the last 10 years, a number of reports have appeared implicating lidocaine as a possible cause of neurologic complications after spinal anesthesia. Follow-up of patients who received uncomplicated spinal anesthesia revealed that some of them developed pain in the lower extremities-transient neurologic symptoms (TNS). In this study, we sought to compare the frequency of 1) TNS and 2) neurologic complications after spinal anesthesia with lidocaine with that after other local anesthetics.