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LETTER TO THE EDITOR

Persisting Neurological Symptoms After Uncomplicated Intrathecal Bupivacaine

Department of Anesthesia; Faculté de Médecine; Université Paris-Descartes; Assistance Publique Hôpitaux de Paris, Hôpital Cochin,; Paris, France; claude.lentschener{at}cch.ap-hop-paris.fr

In Response:

Röhm and Boldt (1) remind us that (a) intrathecal bupivacaine may cause dose-dependent disabling neurological impairment; (b) clinical and laboratory studies suggest that the concentration at nerve roots may be an important factor for this toxicity; and (c) fortunately, this adverse event is rare. Röhm and Boldt provide adequate references in this respect. To emphasize their point, they report 15-day neurological impairment after intrathecal bupivacaine administration. Because an impairment lasting this long meets the definition of transient neurological syndrome, it was outside of our article's scope (2).

Our message was that long-lasting disabling neurological impairment may also occur after a single uneventful intrathecal administration of bupivacaine, given in the absence of any predisposing factors that might result in maldistribution of local anesthetic. In our patient, the sensory levels were bilateral and symmetric, caudal to the expected level, and the neurological impairment persisted for 2 yr (2).

REFERENCES

1. Röhm KD, Boldt J. Persisting neurological symptoms after uncomplicated intrathecal bupivacaine. Anesth Analg 2006;103:1047.[Free Full Text]
2. Chabbouh T, Lentschener C, Zuber M, et al. Persistent cauda equina syndrome with no identifiable facilitating condition after uneventful single spinal administration of 0.5% hyperbaric bupivacaine. Anesth Analg 2005;101:1847–8.[Abstract/Free Full Text]

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