Cauda equina syndrome after continuous spinal anesthesia.
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.
Rigler
M L
ML
Department of Anesthesia, University of California, San Francisco.
Drasner
K
K
Krejcie
T C
TC
Yelich
S J
SJ
Scholnick
F T
FT
DeFontes
J
J
Bohner
D
D
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*
D013748:Tetracaine; D008012:Lidocaine