Cauda Equina Syndrome After Continuous Spinal Anesthesia

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Anesth Analg 1991; 72:275-281
© 1991 International Anesthesia Research Society

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Cauda Equina Syndrome After Continuous Spinal Anesthesia

Mark L. Rigler, MD, Kenneth Drasner, MD, Tom C. Krejcie, MD, Sharon J. Yelich, MD, Faith T. Scholnick, DO, James DeFontes, MD, and David Bohner, CRNA

Abstract

Four cases of cauda equina syndrome occurring after continuousspinal anesthesia are reported. In all four cases, there wasevidence of a focal sensory block and, to achieve adequate analgesia,a dose of local anesthetic was given that was greater than thatusually administered with a single-injection technique. We postulatethat the combination of maldistribution and a relatively highdose of local anesthetic resulted in neurotoxic injury. Suggestionsthat may reduce the potential for neurotoxicity are discussed.Use of a lower concentration and a "ceiling" or maximum doseof local anesthetic to establish the block should be considered.If maldistribution of local anesthetic is suspected (as indicatedby a focal sensory block), the use of maneuvers to increasethe spread of local anesthetic is recommended. If such maneuversprove unsuccessful, the technique should be abandoned.

Key Words: ANESTHETIC TECHNIQUES, SPINAL, CONTINUOUS • COMPLICATIONS, NEUROLOGIC-cauda equina • ANESTHETICS, LOCAL-lidocaine, tetracaine

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598 Print ISSN: 0003-2999

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				Y. Koizumi, M. Matsumoto, A. Yamashita, S. Tsuruta, T. Ohtake, and T. Sakabe The effects of an AMPA receptor antagonist on the neurotoxicity of tetracaine intrathecally administered in rabbits. Anesth. Analg., March 1, 2006; 102(3): 930 - 936. [Abstract] [Full Text] [PDF]

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				S. Sakura, Y. Kirihara, T. Muguruma, T. Kishimoto, and Y. Saito The Comparative Neurotoxicity of Intrathecal Lidocaine and Bupivacaine in Rats Anesth. Analg., August 1, 2005; 101(2): 541 - 547. [Abstract] [Full Text] [PDF]

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				D. Zaric, C. Christiansen, N. L. Pace, and Y. Punjasawadwong Transient Neurologic Symptoms After Spinal Anesthesia with Lidocaine Versus Other Local Anesthetics: A Systematic Review of Randomized, Controlled Trials Anesth. Analg., June 1, 2005; 100(6): 1811 - 1816. [Abstract] [Full Text] [PDF]

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