AANA Journal course: transient neurologic symptoms and spinal anesthesia

A universal goal of anesthesia providers is to provide the safest, most effective anesthesia and analgesia for their patients. When reports emerge showing problems or complications with an agent or technique that previously was thought safe, recommendations often are adopted in anesthesia departments to avoid or abandon the agent or technique, or alternatives are sought. Hyperbaric 5% lidocaine has been an effective and safe spinal anesthetic agent for short procedures for years. During the past decade, controversy arose over its use because it was implicated as the cause of transient neurologic symptoms and cauda equina syndrome. Use of bupivacaine or tetracaine results in a much lower incidence, but these agents are not as well suited to brief or outpatient procedures as is the shorter acting lidocaine. Substantial research has been conducted detailing the search for reasons these complications occur and how to prevent them. A sample of the findings is summarized in an attempt to present current knowledge about the apparent causes and prevention of transient neurologic symptoms. There is promising research showing that safe and effective short-acting intrathecal anesthesia can be accomplished with procaine, prilocaine, meperidine, and sufentanil.