title: Transient adverse neurologic effects of spinal pain blocks.
abstract: OBJECTIVE
  Chronic neck or back pain can be managed with various procedures. Although these procedures are usually well-tolerated, a variety of side effects have been reported. In this study we reviewed cases of unexpected temporary adverse events after blocks and suggest possible causes.
  
  
  METHODS
  We reviewed the records of patients treated with spinal pain blocks between December 2009 and January 2011. The types of blocks performed were medial branch blocks, interlaminar epidural blocks and transforaminal epidural blocks. During the first eight months of the study period (Group A), 2% mepivacaine HCL and triamcinolone was used, and during the last six months of the study period (Group B), mepivacaine was diluted to 1% with normal saline.
  
  
  RESULTS
  There were 704 procedures in 613 patients. Ten patients had 12 transient neurologic events. Nine patients were in Group A and one was in Group B. Transient complications occurred in four patients after cervical block and in eight patients after lumbar block. Side effects of lumbar spine blocks were associated with the concentration of mepivacaine (p<0.05). The likely causes were a high concentration of mepivacaine in five patients, inadvertent vascular injection in three patients, intrathecal leak of local anesthetics in one, and underlying conversion disorder in one.
  
  
  CONCLUSIONS
  Spinal pain blocks are a good option for relieving pain, but clinicians should always keep in mind the potential for development of inevitable complications. Careful history-taking, appropriate selection of the anesthetics, and using real-time fluoroscopy could help reduce the occurrence of adverse events.
authors.affiliation: Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, Korea.
authors.forename: Han-Il
authors.initials: HI
authors.lastname: Lee
authors.forename: Yong-Sook
authors.initials: YS
authors.lastname: Park
authors.forename: Tack-Geun
authors.initials: TG
authors.lastname: Cho
authors.forename: Seung-Won
authors.initials: SW
authors.lastname: Park
authors.forename: Jeong-Taik
authors.initials: JT
authors.lastname: Kwon
authors.forename: Young-Baeg
authors.initials: YB
authors.lastname: Kim
keywords: Adverse effect; C2 ganglion block; Conversion disorder; Medial branch blocks; Paralysis; Spinal pain