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International Pain and Spine Intervention Society Emergency Protocols: Intradural or Intrathecal Local Anesthetic
Ameet S Nagpal1, Stephan Klessinger2, Patrick H Waring3
1Medical University of South Carolina College of Medicine, Charleston, SC, USA.
Abstract:
This protocol reviews unintentional intradural or intrathecal injection during epidural procedures and the potentially serious neurologic and cardiopulmonary consequences that may result. It explains the importance of recognizing abnormal contrast flow patterns and using multiplanar fluoroscopic imaging to avoid inadvertent needle placement and/or anesthetic administration. Emergency management includes stopping the procedure, initiating airway and cardiovascular support as needed, neurologic monitoring, and prolonged observation until the anesthetic effects resolve.
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