title: [Complications of regional anesthesia: diagnostic and management].
abstract: Neuroaxial anesthesia has become an integral part of perioperative pain therapy and provides several advantages over systemic opioids. Despite these benefits, rare but serious complications occur with epidural analgesia including epidural haematoma, spinal-epidural infections and local anesthetic cardiac toxicity. Epidural haematoma and epidural abscess after catheter placement may cause irreversible neurological complications and an immediate diagnostic and therapeutic approach is crucial to assure complete recovery. Furthermore, local anesthetic-induced cardiac toxicity is another rare but potentially lethal complication during regional anesthesia. Based on lipophilic and hydrophilic properties, local anesthetics can interfere with ion channels such as sodium, potassium and calcium channels of the CNS and the heart leading to severe neuronal and cardiac (arrhythmia and contractile depression) adverse effects. In this review we take an in-depth look at severe complications associated with regional anesthesia, describe their symptoms and discuss appropriate diagnostic and therapeutical approaches.
authors.affiliation: Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin des Uniklinikums Münster, Germany. pogatzki@anit.uni-muenster.de
authors.forename: Esther M
authors.initials: EM
authors.lastname: Pogatzki-Zahn
authors.forename: Manuel
authors.initials: M
authors.lastname: Wenk
authors.forename: Hansdetlef
authors.initials: H
authors.lastname: Wassmann
authors.forename: Walter L
authors.initials: WL
authors.lastname: Heindel
authors.forename: Hugo
authors.initials: H
authors.lastname: Van Aken
mesh_terms: D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects*; D000765:Anesthesia, Conduction / Q000009:adverse effects* / Q000379:methods*; D005858:Germany; D006801:Humans; D009422:Nervous System Diseases / Q000209:etiology / Q000517:prevention & control*; D010149:Postoperative Pain / Q000175:diagnosis* / Q000517:prevention & control*; D011182:Postoperative Care / Q000379:methods*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends
chemical_list: D000700:Analgesics