Neurological complications of central nerve blocks

According to frequently cited investigations published 20 to 40 years ago (1-8), transient or permanent nerve lesions are extremely rare complications to spinal and epidural (central) nerve blocks. The current incidence of serious complications seems to remain low as in a combined series of patients undergoing epidural anaesthesia published between 1976 and 1989 comprising a total of 58 407 cases (913) no case was seen of the most feared complication, spinal haematoma. In the case series reviewed by Tryba (1 4), three patients out of 850 000 developed a spinal haematoma following epidural anaesthesia, whereas no case was seen after 650 000 spinal blocks. Metaanalysis estimated the risk for a spinal haematorna to be 0.0007% following epidural anaesthesia and 0.0005% after spinal anaesthesia. A recent very large prospective multieentre study of epidural anaesthesia (1 5), although based exclusively upon an obstetric material, provides further support for the opinion that the technique is associated with a very low risk of neurological complications of 108 events in 505 000 blocks, only five were associated with permanent disability

[1]  P. Tarkkila,et al.  Transient radicular irritation after spinal anaesthesia with hyperbaric 5% lignocaine. , 1995, British journal of anaesthesia.

[2]  G. Y. Wong,et al.  Preoperative Antiplatelet Therapy Does Not Increase the Risk of Spinal Hematoma Associated with Regional Anesthesia , 1995, Anesthesia and analgesia.

[3]  J. Vermylen,et al.  Anticoagulants and Spinal‐Epidural Anesthesia , 1994, Anesthesia and analgesia.

[4]  S. Howell,et al.  Spinal cord compression immediately following, but unrelated to, epidural analgesia , 1994, Anaesthesia.

[5]  M. Gemma,et al.  Neurologic symptoms after epidural anaesthesia. Report of three cases , 1994, Acta anaesthesiologica Scandinavica.

[6]  J. Zacny,et al.  The Effect of Phenobarbital on Psychomotor Recovery after Sevoflurane , 1994 .

[7]  J. T. Martin,et al.  Lower‐extremity Motor Neuropathy Associated with Surgery Performed on Patients in a Lithotomy Position , 1994, Anesthesiology.

[8]  A. Deschamps,et al.  LOW–MOLECULAR–WEIGHT HEPARIN AND EPIDURAL/SPINAL ANAESTHESIA – IS THERE A RISK? , 1994, Acta anaesthesiologica Scandinavica.

[9]  J. E. Pollock,et al.  Spinal Anesthetics and the Incidence of Transient Radicular Irritation , 1994, Regional Anesthesia & Pain Medicine.

[10]  L. F. Redick.  Response to Catheter Insertion and Incidence of Paresthesias and Failure Rate in Continuous Epidural Anesthesia , 1994, Regional Anesthesia & Pain Medicine.

[11]  D. Selander.  Neurotoxicity of Local Anesthetics: Animal Data , 1993, Regional Anesthesia & Pain Medicine.

[12]  T. Horlocker.  When to Remove a Spinal or Epidural Catheter in an Anticoagulated Patient , 1993, Regional Anesthesia & Pain Medicine.

[13]  T. Ettlin,et al.  Transient neurologic toxicity after hyperbaric subarachnoid anesthesia with 5% lidocaine. , 1993, Anesthesia and analgesia.

[14]  J. J. Stone,et al.  Epidural Catheter-induced Traumatic Radiculopathy in Obstetrics: One Center's Experience , 1993, Regional Anesthesia & Pain Medicine.

[15]  H. Muñoz,et al.  Direction of Catheter Insertion and Incidence of Paresthesias and Failure Rate in Continuous Epidural Anesthesia: A Comparison of Cephalad and Caudad Catheter Insertion , 1992, Regional Anesthesia & Pain Medicine.

[16]  A. Johansson,et al.  Liten blödningsrisk med trombosprofylax vid regionalanestesi visar enkätstudie , 1992 .

[17]  B. Lindblad,et al.  Low molecular weight heparin for thromboprophylaxis and epidural/spinal anaesthesia – is there a risk? , 1992, Acta anaesthesiologica Scandinavica.

[18]  R. McCarthy,et al.  Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. , 1991, Anesthesia and analgesia.

[19]  B. Green,et al.  Complications of epidural anesthesia: MR appearance of abnormalities. , 1991, Radiology.

[20]  S. Waldman.  Epidural abscess associated with epidural catheterization. , 1991, Anesthesiology.

[21]  B. Partridge,et al.  The effects of local anesthetics and epinephrine on rat sciatic nerve blood flow. , 1991, Anesthesiology.

[22]  W. E. Strong,et al.  Epidural abscess associated with epidural catheterization: a rare event? Report of two cases with markedly delayed presentation. , 1991, Anesthesiology.

[23]  Y. Hachiya,et al.  Blood supply of nerve roots and dorsal root ganglia. , 1991, The Orthopedic clinics of North America.

[24]  T. Gordh.  On Spinal Anaesthesia—Experiences Over 40 Years , 1990, Regional Anesthesia & Pain Medicine.

[25]  R. Groen,et al.  The spontaneous spinal epidural hematoma A study of the etiology , 1990, Journal of the Neurological Sciences.

[26]  D. Sage.  Epidurals, Spinals and Bleeding Disorders in Pregnancy: A Review , 1990, Anaesthesia and intensive care.

[27]  B M Hibbard,et al.  Serious non-fatal complications associated with extradural block in obstetric practice. , 1990, British journal of anaesthesia.

[28]  K. Olmarker,et al.  Effects of experimental graded compression on blood flow in spinal nerve roots. A vital microscopic study on the porcine cauda equina , 1989, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[29]  S. Waldman.  Complications of Cervical Epidural Nerve Blocks with Steroids: A Prospective Study of 790 Consecutive Blocks , 1989, Regional Anesthesia & Pain Medicine.

[30]  C. Goodchild,et al.  Low‐dose heparin therapy and spinal anaesthesia , 1989, Anaesthesia.

[31]  H. Rutberg,et al.  Spinal haematoma following epidural analgesia , 1988, Anaesthesia.

[32]  E. Hew,et al.  A comparison of two types of epidural catheters , 1987, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[33]  J. Katz,et al.  Handbook of thoraco-abdominal nerve block , 1987 .

[34]  E. Hessel,et al.  Spinal Subarachnoid Hematoma after Lumbar Puncture and Heparinization: A Case Report, Review of the Literature, and Discussion of Anesthetic Implications , 1986, Anesthesia and analgesia.

[35]  J. Link,et al.  Changes in intracranial pressure associated with extradural anaesthesia. , 1986, British journal of anaesthesia.

[36]  B. Hindman,et al.  Usefulness of the post-aspirin bleeding time. , 1986, Anesthesiology.

[37]  J. S. Crawford.  Some maternal complications of epidural analgesia for labour , 1985, Anaesthesia.

[38]  S. Wainapel,et al.  Paraplegia following epidural anesthesia , 1985, Acta neurologica Scandinavica.

[39]  N. Hirsch,et al.  Paraplegia caused by spinal angioma--possible association with epidural analgesia. , 1985, Anesthesia and analgesia.

[40]  C. Veelen,et al.  Spontaneous spinal epidural haematoma Etiological considerations , 1984, Clinical Neurology and Neurosurgery.

[41]  A. McDonogh,et al.  Delayed presentation of an epidural abscess. , 1984, Anaesthesia and intensive care.

[42]  McDonogh Aj,et al.  Delayed presentation of an epidural abscess. , 1984 .

[43]  B. Newman.  Postnatal paraparesis following epidural analgesia and forceps delivery. , 1984, Anaesthesia.

[44]  B. Benoit,et al.  Spinal subdural hematoma. A review. , 1983, Surgical neurology.

[45]  B. Newman.  Postnatal paraparesis following epidural analgesia and forceps delivery , 1983 .

[46]  J. A. Odoom,et al.  Epidural analgesia and anticoagulant therapy , 1983 .

[47]  J. Crowhurst.  Paraplegia following epidural analgesia , 1982, Anaesthesia.

[48]  T. Rao,et al.  Anticoagulation Following Placement of Epidural and Subarachnoid Catheters:: An Evaluation of Neurologic Sequelae , 1981, Anesthesiology.

[49]  N. Ballin.  Paraplegia following epidural analgesia , 1981, Anaesthesia.

[50]  A. Verniquet,et al.  Vessel Puncture with Epidural Catheters: Experience in Obstetric Patients , 1981 .

[51]  R. E. Kane.  Neurologic Deficits following Epidural or Spinal Anesthesia , 1981, Anesthesia and analgesia.

[52]  A. Verniquet.  Vessel puncture with epidural catheters , 1980, Anaesthesia.

[53]  L. S. Chaudhari,et al.  Paraplegia and epidural analgesia , 1978, Anaesthesia.

[54]  Y. Mitsuya,et al.  [Femoral nerve paralysis after abdominal hysterectomy under continuous epidural analgesia: report of two cases (author's transl)]. , 1978, Masui. The Japanese journal of anesthesiology.

[55]  D. Moore,et al.  Bupivacaine: A Review of 11,080 Cases , 1978, Anesthesia and analgesia.

[56]  M. Morgan,et al.  Maternal Complications of Obstetric Epidural Analgesia , 1976 .

[57]  Philippa D. Harrison.  Paraplegia following epidural analgesia , 1975, Anaesthesia.

[58]  R. Ojemann,et al.  Spinal epidural abscess. , 1975, The New England journal of medicine.

[59]  H. Edström,et al.  Thoracic Epidural Analgesia I‐A Double‐Blind Study between Bupivacaine and Etidocaine , 1975, Acta anaesthesiologica Scandinavica. Supplementum.

[60]  J. Bonica,et al.  Circulatory Effects of Peridural Block: IV. Comparison of the Effects of Epinephrine and Phenylephrine , 1973, Anesthesiology.

[61]  Janis Km.  Epidurai Hematoma Foliowing Postoperative Epidural Analgesia: A Case Report , 1972 .

[62]  J. Bonica,et al.  Circulatory Effects of Peridural Block: III. Effects of Acute Blood Loss , 1972, Anesthesiology.

[63]  F. N. Low,et al.  The fine structure of the peripheral nerve root sheath in the subarachnoid space in the rat and other laboratory animals. , 1971, The American journal of anatomy.

[64]  G. Ehni.  Significance of the small lumbar spinal canal: cauda equina compression syndromes due to spondylosis. 4. Acute compression artifically-induced during operation. , 1969, Journal of Neurosurgery.

[65]  G. Ehni.  Significance of the small lumbar spinal canal: cauda equina compression syndromes due to spondylosis. 1. Introduction. , 1969, Journal of neurosurgery.

[66]  C. Dawkins.  An analysis of the complications of extradural and caudal block , 1969, Anaesthesia.

[67]  F. N. Low,et al.  The subarachnoid angle: An area of transition in peripheral nerve , 1969, The Anatomical record.

[68]  O. C. Phillips,et al.  Neurologic complications following spinal anesthesia with lidocaine: a prospective review of 10,440 cases. , 1969, Anesthesiology.

[69]  J. Usubiaga,et al.  AND ITS RELATION TO SPREAD OF ANESTHETIC SOLUTIONS IN EPIDURAL SPACE , 1967, Anesthesia and analgesia.

[70]  J. Usubiaga,et al.  Effect of Saline Injecrtions on: EPIDURAL and SUBARACHNOID SPACE PRESSURES and RELATION TO POSTSPINAL ANESTHESIA HEADACHE , 1967, Anesthesia and analgesia.

[71]  W. Wu,et al.  SPINAL EPIDURAL HEMATOMA DURING ANTICOAGULANT THERAPY. REPORT OF TWO CASES. , 1964, Archives of internal medicine.

[72]  G. A. Schwarz,et al.  PARAPLEGIA FOLLOWING SPINAL ANESTHESIA. CLINICOPATHOLOGIC REPORT AND REVIEW OF LITERATURE. , 1964, Archives of neurology.

[73]  R. R. Murray.  MATERNAL OBSTETRICAL PARALYSIS. , 1964, American journal of obstetrics and gynecology.

[74]  M. Gold.  Spontaneous spinal epidural hematoma. , 1963, Radiology.

[75]  P. Lund,et al.  PERIDURAL ANESTHESIA: A Review of 10,000 Administrations , 1962, Acta anaesthesiologica Scandinavica.

[76]  E. Hill.  Maternal obstetric paralysis. , 1962, American journal of obstetrics and gynecology.

[77]  Blaisdell Fw,et al.  The mechanism of paraplegia after temporary thoracic aortic occlusion and its relationship to spinal fluid pressure. , 1962 .

[78]  R. Dripps,et al.  Long-term follow-up of patients who received 10,098 spinal anesthetics. IV. Neurological disease incident to traumatic lumbar puncture during spinal anesthesia. , 1960, Journal of the American Medical Association.

[79]  B. Winer,et al.  Spinal Epidural Hematoma during Anticoagulant Therapy , 1959, Circulation.

[80]  A. Marinacci,et al.  Electromyogram in evaluation of neurological complications of spinal anesthesia. , 1958, Journal of the American Medical Association.

[81]  J. Bonica,et al.  PERIDURAL BLOCK: ANALYSIS OF 3,637 CASES AND A REVIEW , 1957, Anesthesiology.

[82]  R. Dripps,et al.  Long-term follow-up of patients who received 10,098 spinal anesthetics: failure to discover major neurological sequelae. , 1954, Journal of the American Medical Association.

[83]  J. Brierley.  THE PENETRATION OF PARTICULATE MATTER FROM THE CEREBROSPINAL FLUID INTO THE SPINAL GANGLIA, PERIPHERAL NERVES, AND PERIVASCULAR SPACES OF THE CENTRAL NERVOUS SYSTEM , 1950, Journal of neurology, neurosurgery, and psychiatry.

[84]  E. J. Field,et al.  The connexions of the spinal sub-arachnoid space with the lymphatic system. , 1948, Journal of anatomy.

[85]  R. H. de Jong,et al.  Last round for a "heavyweight"? , 1994, Anesthesia and analgesia.

[86]  P. Bromage.  Neurological complications of epidural and spinal techniques , 1993 .

[87]  M. Tryba,et al.  Rückenmarksnahe Regionalanästhesie und niedermolekulare Heparine: Pro und Kontra , 1993 .

[88]  H. Nolte,et al.  [Subdural and epidural hematomas following epidural anesthesia. A literature review]. , 1992, Der Anaesthesist.

[89]  L. Vaes.  Regional anesthesia: how safe? A review of 20,590 cases. , 1988, Acta anaesthesiologica Belgica.

[90]  O. Wilder-Smith,et al.  [Backache following spinal anesthesia--a neglected problem?]. , 1987, Regional-Anaesthesie.

[91]  E. Widerlöv,et al.  Adverse reactions to dextran in Sweden 1970-1979. , 1983, Acta chirurgica Scandinavica.

[92]  F. Regli.  Neurologische Komplikationen bei „wirbelsäulennahen“ Anästhesieformen , 1983 .

[93]  J. Usubiaga.  Neurological complications following epidural anesthesia. , 1975, International anesthesiology clinics.

[94]  T. Kuurne,et al.  Acute paraplegia caused by a spontaneous extradural heamatoma of the conus medullaris area. , 1975, Acta chirurgica Scandinavica.

[95]  F. N. Low,et al.  The fine structure of cellular layers and connective tissue space at spinal nerve root attachments in the rat. , 1972, The American journal of anatomy.

[96]  K. Andres.  [On the fine structure of the arachnoidea and dura mater of mammals]. , 1967, Zeitschrift fur Zellforschung und mikroskopische Anatomie.

[97]  R. Dripps,et al.  A long-term follow-up of 10,098 spinal anesthetics. II. Incidence and analysis of minor sensory neurological defects. , 1955, Surgery.