Cauda equina syndrome after continuous spinal anesthesia

Anesth Analg. 1991 Mar;72(3):275-81. doi: 10.1213/00000539-199103000-00001.

Abstract

Four cases of cauda equina syndrome occurring after continuous spinal anesthesia are reported. In all four cases, there was evidence of a focal sensory block and, to achieve adequate analgesia, a dose of local anesthetic was given that was greater than that usually administered with a single-injection technique. We postulate that the combination of maldistribution and a relatively high dose of local anesthetic resulted in neurotoxic injury. Suggestions that may reduce the potential for neurotoxicity are discussed. Use of a lower concentration and a "ceiling" or maximum dose of local anesthetic to establish the block should be considered. If maldistribution of local anesthetic is suspected (as indicated by a focal sensory block), the use of maneuvers to increase the spread of local anesthetic is recommended. If such maneuvers prove unsuccessful, the technique should be abandoned.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anesthesia, Spinal / adverse effects*
  • Cauda Equina / drug effects*
  • Female
  • Humans
  • Lidocaine / adverse effects*
  • Male
  • Middle Aged
  • Nerve Compression Syndromes / chemically induced*
  • Nerve Compression Syndromes / physiopathology
  • Postoperative Complications / chemically induced*
  • Postoperative Complications / physiopathology
  • Tetracaine / adverse effects*

Substances

  • Tetracaine
  • Lidocaine