Conus medullaris injury following both tetracaine and lidocaine spinal anesthesia.
Multiple reports of cauda equina syndrome and transient radicular nerve root irritation have suggested that lidocaine spinal anesthesia may be responsible. In this case report, a patient with a preexisting diabetic neuropathy received a partial block following a tetracaine spinal, which was followed by a lidocaine spinal. Following block resolution, a new conus medullaris syndrome was diagnosed. Because of the close proximity of the cauda equina and the conus medullaris, differentiation between these syndromes can be difficult. The preexisting diabetic neuropathy may have predisposed this patient to neurologic injury. The choice of a different local anesthetic drug with less neurotoxic potential such as bupivacaine may have prevented this injury.
Waters
J H
JH
Department of Anesthesiology, University of California, Irvine, Orange 92668, USA.
Watson
T B
TB
Ward
M G
MG
D000775:Anesthesia, Spinal / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage; D002420:Cauda Equina; D002944:Circumcision, Male; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003929:Diabetic Neuropathies / Q000150:complications; D017558:Elective Surgical Procedures; D005500:Follow-Up Studies; D006801:Humans; D008012:Lidocaine / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects; D009408:Nerve Compression Syndromes / Q000175:diagnosis; D013116:Spinal Cord / Q000187:drug effects*; D013117:Spinal Cord Compression / Q000139:chemically induced*; D013748:Tetracaine / Q000009:adverse effects*
D000779:Anesthetics, Local; D013748:Tetracaine; D008012:Lidocaine; D002045:Bupivacaine