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Regional anaesthesia in the patient with pre-existing neurological dysfunction

  • T. T. Horlocker

Abstract

Patients with pre-existing neurological disease present a unique challenge to the anaesthesiologist. The cause of postoperative neurological deficits is difficult to evaluate, because neural injury may occur as a result of surgical trauma, tourniquet pressure, prolonged labour, or improper patient positioning or anaesthetic technique. Progressive neurological diseases such as multiple sclerosis may coincidentally worsen perioperatively, independently of the anaesthetic method. The most conservative legal approach is to avoid regional anaesthesia in these patients. However, high-risk patients, including those with significant cardiopulmonary disease, may benefit medically from regional anaesthesia and analgesia. The decision to proceed with regional anaesthesia in these patients should be made on a case-by-case basis. Meticulous regional anaesthetic technique should be observed to minimise further neurological injury.

Keywords

Multiple Sclerosis Spinal Stenosis Neurological Injury Dural Puncture Cauda Equina Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Gower DJ, Baker EL, Bell WO et al (1987) Contraindications to lumbar puncture as defined by computed cranial tomography. J Neurol Neurosurg Psychiatry 50:1071–1074PubMedGoogle Scholar
  2. 2.
    Wedel DJ, Mulroy MF (1983) Hemiparesis following dural puncture. Anesthesiology 59:475–477PubMedCrossRefGoogle Scholar
  3. 3.
    Sakabe T, Maekawa T, Ishikawa T, Takeshita H (1974) The effects of lidocaine on canine cerebral metabolism and circulation related to the electroencephalogram. Anesthesiology 40:433–441PubMedCrossRefGoogle Scholar
  4. 4.
    Usubiaga JE, Wikinski J, Ferrero R et al (1966) Local anesthetic-induced convulsions in man—an electroencephalographic study. Anesth Analg 45:611–620PubMedGoogle Scholar
  5. 5.
    Perkins WJ, Jr, Lanier WL, Sharbrough FW (1988) Cerebral and hemodynamic effects of lidocaine accidentally injected into the carotid arteries of patients having carotid endarterectomy. Anesthesiology 69:787–790PubMedCrossRefGoogle Scholar
  6. 6.
    Phillips OC, Ebner H, Nelson AT, Black MH (1969) Neurologic complications following spinal anesthesia with lidocaine: a prospective review of 10, 440 cases. Anesthesiology 30:284–289PubMedCrossRefGoogle Scholar
  7. 7.
    Selander D, Edshage S, Wolff T (1979) Paresthesiae or no paresthesiae? Nerve lesions after axillary blocks. Acta Anaesthesiol Scand 23:27–33PubMedGoogle Scholar
  8. 8.
    Selander D, Dhuner KG, Lundborg G (1977) Peripheral nerve injury due to injection needles used for regional anesthesia. An experimental study of the acute effects of needle point trauma. Acta Anaesthesiol Scand 21:182–188PubMedCrossRefGoogle Scholar
  9. 9.
    Rice AS, McMahon SB (1992) Peripheral nerve injury caused by injection needles used in regional anaesthesia: influence of bevel configuration, studied in a rat model. Br J Anaesth 69:433–438PubMedCrossRefGoogle Scholar
  10. 10.
    Schneider M, Ettlin T, Kaufmann M et al (1993) Transient neurologic toxicity after hyperbaric subarachnoid anesthesia with 5% lidocaine. Anesth Analg 76:1154–1157PubMedCrossRefGoogle Scholar
  11. 11.
    Myers RR, Heckman HM (1989) Effects of local anesthesia on nerve blood flow: studies using lidocaine with and without epinephrine. Anesthesiology 71:757–762PubMedCrossRefGoogle Scholar
  12. 12.
    Kalichman MW, Calcutt NA (1992) Local anesthetic-induced conduction block and nerve fiber injury in streptozotocin-diabetic rats. Anesthesiology 77:941–947PubMedCrossRefGoogle Scholar
  13. 13.
    Rigler ML, Drasner K, Krejcie TC et al (1991) Cauda equina syndrome after continuous spinal anesthesia. Anesth Analg 72:275–281PubMedCrossRefGoogle Scholar
  14. 14.
    Drasner K (1993) Models for local anesthetic toxicity from continuous spinal anesthesia. Reg Anesth 18:434–438PubMedGoogle Scholar
  15. 15.
    Selander D (1993) Neurotoxicity of local anesthetics: animal data. Reg Anesth 18:461–468PubMedGoogle Scholar
  16. 16.
    Yee TC, Kalichman MW (1997) Effects of aging on nerve conduction block induced by bupivacaine and procaine in rats. J Periph Nerv System 2:175–179Google Scholar
  17. 17.
    Bromage PR (1976) Paraplegia following epidural analgesia: a misnomer. Anaesthesia 31:947–949PubMedCrossRefGoogle Scholar
  18. 18.
    Kane RE (1981) Neurologic deficits following epidural or spinal anesthesia. Anesth Analg 60:150–161PubMedCrossRefGoogle Scholar
  19. 19.
    Hebl JR, Horlocker TT, Sorenson EJ, Schroeder DR (2001) Regional anesthesia does not increase the risk of postoperative neuropathy in patients undergoing ulnar nerve transposition. Anesth Analg 93:1606–1611PubMedCrossRefGoogle Scholar
  20. 20.
    Crawford J, James FI, Nolte H (1981) Regional analgesia for patients with chronic neurological disease and similar conditions. Anaesthesia 36:821CrossRefGoogle Scholar
  21. 21.
    Warren TM, Datta S, Ostheimer GW (1982) Lumbar epidural anesthesia in a patient with multiple sclerosis. Anesth Analg 61:1022–1023PubMedCrossRefGoogle Scholar
  22. 22.
    Hebl JR, Horlocker TT, Schroeder DR (2005) Neurologic complications after neuraxial anesthesia or analgesia in patients with pre-existing spinal stenosis or lumbar disc disease. Reg Anesth Pain Med 29:A89Google Scholar
  23. 23.
    Singelyn FJ, Gerard C, Fuzier R (2005) The influence of diabetes mellitus on the success rate of posterior popliteal sciatic nerve blockade. Anesthesiology A-1125Google Scholar
  24. 24.
    Laasonen EM, Soini J (1989) Low-back pain after lumbar fusion. Surgical and computed tomographic analysis. Spine 14:210–213PubMedCrossRefGoogle Scholar
  25. 25.
    Daley MD, Rolbin SH, Hew EM et al (1990) Epidural anesthesia for obstetrics after spinal surgery. Reg Anesth 15:280–284PubMedGoogle Scholar
  26. 26.
    Crosby ET, Halpern SH (1989) Obstetric epidural anaesthesia in patients with Harrington instrumentation. Can J Anaesth 36:693–696PubMedCrossRefGoogle Scholar
  27. 27.
    Hubbert CH (1985) Epidural anesthesia in patients with spinal fusion. Anesth Analg 64:843PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • T. T. Horlocker
    • 1
  1. 1.Department of Anesthesiology and OrthopedicsMayo Clinic College of MedicineRochesterUSA

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