Neurologic complications of 603 consecutive continuous spinal anesthetics using macrocatheter and microcatheter techniques. Perioperative Outcomes Group.
Recent case reports of cauda equina syndrome after continuous spinal anesthesia have led to a reevaluation of the indications and applications of this regional anesthetic technique. However, few large studies have formally investigated the frequency of neurologic complications using macro- and microcatheter (smaller than 24 gauge) techniques. This retrospective review examines 603 continuous spinal anesthetics, including 127 administered through a 28-gauge microcatheter, performed between June 1987 and May 1992. The surgical procedure was orthopedic in 397 of 476 (83.4%) macrocatheter patients. All microcatheter patients were parturients. Three patients reported pain (persistent paresthesia) postoperatively. In two patients, the symptoms resolved in 4 days; the other patient was discharged 8 days postoperatively with residual foot pain. There was also one patient with aseptic meningitis and one patient with a sensory cauda equina syndrome (still present after 15 mo). There were 58 (9.6%) patients with a postdural puncture headache (PDPH), including 42 of 127 (33.1%) patients in the microcatheter group. An epidural blood patch was performed in 41 (6.8%) patients. The frequency of neurologic complications, excluding PDPH, is similar to those in published reviews. However, PDPH in microcatheter patients is more frequent than previously reported.
Horlocker
T T
TT
Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
McGregor
D G
DG
Matsushige
D K
DK
Chantigian
R C
RC
Schroeder
D R
DR
Besse
J A
JA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D000775:Anesthesia, Spinal / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D002420:Cauda Equina; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D008297:Male; D008582:Meningitis, Aseptic / Q000209:etiology; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000209:etiology; D009422:Nervous System Diseases / Q000139:chemically induced / Q000209:etiology*; D010292:Paresthesia / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors
D000701:Analgesics, Opioid; D000779:Anesthetics, Local