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Obstetric Anaesthesia, St. James’ University Hospital, Leeds, UK, glyons{at}blocked.org.uk
To the Editor:
I read with interest the case report by Ming-Chang Kao et al. regarding the inadvertent spinal cord injury during thoracic epidural catheterization in the anesthetized patient. They state that in their department the "insertion of thoracic epidurals in the anesthetized patient is now forbidden" and "If the technique in the awake patient is truly not feasible, a lumbar epidural should be considered" (1). They make the assumption that in the awake patient cord damage will be avoided.
In a series of seven cases of inadvertent cord injury in the awake patient with either single-shot spinal or combined spinal-epidural all were in the L2-3 interspace (2). What makes this more surprising is that pain or discomfort appears to have been associated with the needle insertion or the injection and this did not prevent cord damage.
Cord damage appears to be a complication of centroneuraxial blockade irrespective of the technique, state of consciousness, or intended segmental level. Uncomfortable as it may be, perhaps attention is most needed in improving regional anesthesia training and raising the level of expertise.
Dr. Hu did not reply.
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