[Spinal and regional anesthesia in bacteremia]

Area of Science:

• Anesthesiology
• Infectious Diseases
• Neurology

Context:

• Central neural axis (CNA) blocks, including spinal and epidural anesthesia, are common procedures.
• Bacteraemia (bacteria in the bloodstream) and septicaemia (sepsis) are traditionally considered contraindications for CNA blocks due to theoretical risks of central nervous system (CNS) infection.
• Infectious complications following diagnostic lumbar puncture or regional anesthesia are rare.

Purpose:

• To review the existing literature on the risk of haematogenous central nervous system infection following CNA blocks in patients with bacteraemia.
• To evaluate whether bacteraemia should be considered an absolute or relative contraindication for CNA blocks.
• To provide evidence-based recommendations for managing patients with bacteraemia undergoing regional anesthesia.

Summary:

• While theoretical risks exist, such as accidental vessel puncture or altered cerebrospinal fluid dynamics, evidence directly linking bacteraemia to increased CNS infection after CNA blocks is limited.
• Studies in animals show meningitis can be induced, but human data does not confirm an elevated risk for bacteraemic patients.
• The review suggests bacteraemia is a relative contraindication, necessitating careful patient selection and monitoring.

Impact:

• Bacteraemia should be viewed as a relative contraindication for CNA blocks, not an absolute one.
• Recommendations include antibiotic chemoprophylaxis before puncture and close post-anesthesia surveillance for CNS infections, particularly spinal epidural abscess.
• Informed consent is crucial due to the potential, albeit low, increased risk of infectious complications.