title: Cauda equina syndrome after continuous spinal anesthesia.
abstract: 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 single-injection technique. We 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.
authors.affiliation: Department of Anesthesia, University of California, San Francisco.
authors.forename: M L
authors.initials: ML
authors.lastname: Rigler
authors.forename: K
authors.initials: K
authors.lastname: Drasner
authors.forename: T C
authors.initials: TC
authors.lastname: Krejcie
authors.forename: S J
authors.initials: SJ
authors.lastname: Yelich
authors.forename: F T
authors.initials: FT
authors.lastname: Scholnick
authors.forename: J
authors.initials: J
authors.lastname: DeFontes
authors.forename: D
authors.initials: D
authors.lastname: Bohner
mesh_terms: D000368:Aged; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D002420:Cauda Equina / Q000187:drug effects*; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000139:chemically induced* / Q000503:physiopathology; D011183:Postoperative Complications / Q000139:chemically induced* / Q000503:physiopathology; D013748:Tetracaine / Q000009:adverse effects*
chemical_list: D013748:Tetracaine; D008012:Lidocaine