Infectious complications of regional anaesthesia

  • D. J. Wedel
Conference paper


Infectious complications may occur after any regional anaesthetic technique, but are of greatest concern if the infection occurs near or within the central neuraxis. Possible risk factors include underlying sepsis, diabetes, depressed immune status, steroid therapy, localised bacterial colonisation or infection, and chronic catheter maintenance. Bacterial infection of the central neuraxis may present as meningitis or cord compression secondary to abscess formation. The infectious source may be exogenous (e.g. contaminated equipment or medication), or endogenous (a bacterial source in the patient seeding to the needle or catheter site). Microorganisms can also be transmitted via a break in aseptic technique, and indwelling catheters may be colonised from a superficial site (skin) and subsequently serve as a wick for spread of infection from the skin to the epidural or intrathecal space.


Infectious Complication Regional Anaesthesia Epidural Abscess Dural Puncture Spinal Epidural Abscess 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kane RE (1981) Neurologic deficits following epidural or spinal anesthesia. Anesth Analg 60:150–161PubMedCrossRefGoogle Scholar
  2. 2.
    Auroy Y, Narchi P, Messiah A et al (1997) Serious complications related to regional anesthesia: Results of a prospective survey in France. Anesthesiology 87:479–486PubMedCrossRefGoogle Scholar
  3. 3.
    Horlocker TT, McGregor DG, Matsushige DK et al (1997) A retrospective review of 4767 consecutive spinal anesthetics: central nervous system complications. Anesth Analg 84:578–584PubMedCrossRefGoogle Scholar
  4. 4.
    Weed LH, Wegeforth P, Ayer JB et al (1919) The production of meningitis by release of cerebrospinal fluid during an experimental septicemia. JAMA 72:190–193Google Scholar
  5. 5.
    Wegeforth P, Latham JR (1919) Lumbar puncture as a factor in the causation of meningitis. Am J Med Sci 158:183–202CrossRefGoogle Scholar
  6. 6.
    Pray LG (1941) Lumbar puncture as a factor in the pathogenesis of meningitis. AmJ Dis Child 295:62–68Google Scholar
  7. 7.
    Eng RHK, Seligman SJ (1981) Lumbar puncture-induced meningitis. JAMA 245:1456–1459PubMedCrossRefGoogle Scholar
  8. 8.
    Teele DW, Dashefsky B, Rakusan T et al (1981) Meningitis after lumbar puncture in children with bacteremia. N Engl J Med 304:1079–1081CrossRefGoogle Scholar
  9. 9.
    Carp H, Bailey S (1992) The association between meningitis and dural puncture in bacteremic rats. Anesthesiology 76:739–742PubMedCrossRefGoogle Scholar
  10. 10.
    Mamourian AC, Dickman CA, Drayer BP et al (1993) Spinal epidural abscess: three cases following spinal epidural injection demonstrated with magnetic resonance imaging. Anesthesiology 78:204–207PubMedCrossRefGoogle Scholar
  11. 11.
    Du Pen SL, Peterson DG, Williams A et al (1990) Infection during chronic epidural catheterization: Diagnosis and treatment. Anesthesiology 73:905–909PubMedCrossRefGoogle Scholar
  12. 12.
    Darchy B, Forceville X, Bavoux E et al (1996) Clinical and bacteriologic survey of epidural analgesia in patients in the intensive care unit. Anesthesiology 85:988–998PubMedCrossRefGoogle Scholar
  13. 13.
    Baker AS, Ojemann RG, Swartz MN et al (1975) Spinal epidural abscess. N Engl J Med 293:463–468PubMedCrossRefGoogle Scholar
  14. 14.
    Feldman JM, Chapin-Robertson K, Turner J (1994) Do agents used for epidural analgesia have antimicrobial properties? Reg Anesth 19:43–47PubMedGoogle Scholar
  15. 15.
    James III FM, George RH, Naiem H et al (1976) Bacteriologic aspects of epidural analgesia. Anesth Analg 55:187–190PubMedCrossRefGoogle Scholar
  16. 16.
    Hunt JR, Rigor BM, Collins JR (1977) The potential for contamination of continuous epidural catheters. Anesth Analg 56:222–224PubMedCrossRefGoogle Scholar
  17. 17.
    Barreto RS (1962) Bacteriologic Culture of indwelling epidural catheters. Anesthesiology 23:643–646PubMedCrossRefGoogle Scholar
  18. 18.
    De Cicco M, Matovic M, Castellani GT et al (1995) Time-dependent efficacy of bacterial filters and infection risk in long-term epidural catheterization. Anesthesiology 82:765–771PubMedGoogle Scholar
  19. 19.
    Abouleish E, Amortegui AJ, Taylor FH (1977) Are bacterial filters needed in continuous epidural analgesia for obstetrics? Anesthesiology 46:351–354PubMedCrossRefGoogle Scholar
  20. 20.
    Hebl JR (2006) The importanceand implications of aseptic techniques. Reg Anesth Pain Med (in press)Google Scholar
  21. 21.
    Saloojee H, Steenhoff A (2001) The health professional’s role in preventing nosocomial infections. Postgrad Med J 77:16–19PubMedCrossRefGoogle Scholar
  22. 22.
    Moen V, Dahlgren N, Irestedt L (2004) Severe neurological complications after central neuraxial blockades in Sweden 1990–1999. Anesthesiology 101:950–959PubMedCrossRefGoogle Scholar
  23. 23.
    Schneeberger PM, Janssen M, Voss A (1996) Alpha-hemolytic streptococci: a major pathogen of iatrogenic meningitis following lumbar puncture. Case reports and a review of the literature. Infection 24:29–35PubMedCrossRefGoogle Scholar
  24. 24.
    Trautmann M, Lepper PM, Schmitz FJ (2002) Three cases of bacterial meningitis after spinal and epidural anesthesia. Eur J Clin Microbiol Infect Dis 21:43–45PubMedCrossRefGoogle Scholar
  25. 25.
    Couzigou C, Vuong TK, Botherel AH et al (2003) Iatrogenic Streptococcus salivarius meningitis after spinal anaesthesia: need for strict application of standard precautions. J Hosp Infect 53:313–314PubMedCrossRefGoogle Scholar
  26. 26.
    Molinier S, Paris JF, Brisou P et al (1998) Two cases of iatrogenic oral streptococcal infection: meningitis and spondylodiscitis [in French]. Rev Med Interne 19:568–570PubMedCrossRefGoogle Scholar
  27. 27.
    Borgeat A, Ekatodramis G, Kalberer F et al (2001) Acute and nonacute complications associated with interscalene block and shoulder surgery: a prospective study. Anesthesiology 95:875–880PubMedCrossRefGoogle Scholar
  28. 28.
    Capdevila X, Pirat P, Bringuier S et al (2005) Continuous peripheral nerve blocks in hospital wards after orthopedic surgery. Anesthesiology 103:1035–1045PubMedCrossRefGoogle Scholar
  29. 29.
    Cuvillon P, Ripart J, Lalourcey L et al (2001) The continuous femoral nerve block catheter for postoperative analgesia: bacterial colonization, infectious rate and adverse effects. Anesth Analg 93:1045–1049PubMedCrossRefGoogle Scholar
  30. 30.
    Rathmell JP (2006) Infectious risks of chronic pain treatments. Reg Anesth Pain Med (in press)Google Scholar
  31. 31.
    Mangram AJ, Horan TC, Pearson ML et al (1999) Guideline for prevention of surgical site infection, 1999. Hospital Infection Practices Advisory Committee. Infect Control Hosp Epidemiol 20:250–278PubMedCrossRefGoogle Scholar
  32. 32.
    Bergman BD, Hebl JR, Kent J et al (2003) Neurologic complications of 405 consecutive continuous axillary catheters. Anesth Analg 96:247–252PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • D. J. Wedel
    • 1
  1. 1.Department of AnesthesiologyMayo Clinic College of MedicineRochesterUSA

Personalised recommendations