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REGIONAL ANESTHESIA

Transient Neurological Symptoms After Subarachnoid Meperidine

Department of Anesthesiology, VA Connecticut Healthcare System, West Haven, Connecticut, Yale University School of Medicine, New Haven, Connecticut

Address correspondence to Wilfred R. Lewis, MD, Anesthesia Service (186), VA Connecticut Health Care System, 950 Camp- bell Avenue, West Haven, CT 06516. Address e-mail to Wilfred.Lewis{at}med.va.gov

Subarachnoid injection of lidocaine and other local anesthetics has been implicated in the syndrome of transient neurological symptoms (TNS). This syndrome has been well documented in a number of case reports and prospective, randomized controlled trials (1–8). The relatively frequent incidence of this complication with subarachnoid lidocaine has led to the search for alternative local anesthetics, including meperidine.

Although meperidine, an opioid with local anesthetic properties, has not been approved for subarachnoid administration, it has been used in varying degrees for clinical anesthesia over the last 50 yr (9,10). Reported side effects from subarachnoid meperidine have included nausea and vomiting, itching, urinary retention, respiratory depression, and hypotension (11,12). TNS after subarachnoid meperidine has not been reported. We describe a case of TNS after spinal anesthesia with meperidine for a urological procedure.

IMPLICATIONS: The syndrome of transient neurological symptoms (TNS) after subarachnoid use of local anesthetics, particularly lidocaine, has been well described. This syndrome has not been reported with the subarachnoid use of opioids. This case report describes TNS that occurred after administration of subarachnoid meperidine, an opioid with local anesthetic properties.

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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