title: 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.
abstract: Six cases of cauda equina syndrome with varying severity were reported to the Swedish Pharmaceutical Insurance during the period 1993-1997. All were associated with spinal anaesthesia using hyperbaric 5% lignocaine. Five cases had single-shot spinal anaesthesia and one had a repeat spinal anaesthetic due to inadequate block. The dose of hyperbaric 5% lignocaine administered ranged from 60 to 120 mg. Three of the cases were most likely caused by direct neurotoxicity of hyperbaric 5% lignocaine. In the other 3 cases, direct neurotoxicity was also probable, but unfortunately radiological investigations were not done to definitely exclude a compressive aetiology. All cases sustained permanent neurological deficits. We recommend that hyperbaric lignocaine should be administered in concentrations not greater than 2% and at a total dose preferably not exceeding 60 mg.
authors.affiliation: Dept. of Anaesthesia, KK Women's & Children's Hospital, Republic of Singapore.
authors.forename: C C
authors.initials: CC
authors.lastname: Loo
authors.forename: L
authors.initials: L
authors.lastname: Irestedt
mesh_terms: D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000775:Anesthesia, Spinal / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D002420:Cauda Equina / Q000187:drug effects*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000139:chemically induced*; D010410:Penile Erection; D011312:Pressure; D012678:Sensation Disorders / Q000209:etiology; D013548:Sweden; D014549:Urinary Incontinence / Q000209:etiology; D014555:Urination Disorders / Q000209:etiology
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine