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Persistent sacral nerve root deficits after continuous spinal anaesthesia.

R M Schell1, F S Brauer, D J Cole

  • 1Department of Anesthesiology, Loma Linda University, California 92350.

Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|October 1, 1991
PubMed
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Persistent neurological deficits, including sacral nerve root damage, are rare complications of continuous spinal anaesthesia (CSA) using high-dose lidocaine via microcatheter. This suggests a risk of localized neurotoxicity due to uneven drug distribution.

Area of Science:

  • Anesthesiology
  • Neuroscience
  • Toxicology

Background:

  • Spinal anaesthesia is a common procedure for lower body surgeries.
  • Neurological deficits are rare but serious complications.
  • Continuous spinal anaesthesia (CSA) allows for prolonged anaesthetic effect.

Observation:

  • Two cases of persistent sacral nerve root deficits after CSA using hyperbaric lidocaine via lumbar microcatheter are reported.
  • Both patients received higher than usual doses of 5% lidocaine.
  • Neurological deficits included perianal hypaesthesia, lower extremity paresis, urinary retention, and defecation difficulties.

Findings:

  • Both patients experienced residual perianal hypaesthesia and difficult defecation.
  • High-dose requirements and focal sensory block suggest non-uniform distribution of hyperbaric lidocaine.

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  • Microcatheter use in CSA may pose a unique risk of local anaesthetic maldistribution and neurotoxicity.

    • Implications:

    • This highlights a potential risk associated with microcatheter-guided CSA, particularly with high local anaesthetic doses.
    • Further research is needed to understand the mechanisms of local neurotoxicity and maldistribution.
    • Anesthesiologists should consider the potential risks of microcatheter techniques and high-dose local anaesthetics in CSA.