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July 1997
A retrospective review of 4,767 consecutive spinal anesthetics: Central nervous system complications.
Horlocker TT, McGregor BG, Matsushige DK, et al.Anesthesia Analgesia 1997; 84:578-84.
[ see abstract below ]
Spinal anesthesia has been long used, and has been associated with a low rate of neurological complications. In several large studies prior to 1970 totaling over 50,000 anesthetics, the reported incidence of minor sensory neurological deficits range from 0-0.7%, and minor motor deficits from 0.005-0.02%. The practice of spinal anesthesia has changed since those studies, with differences in spinal needles and spinal anesthetic agents.
These authors performed a retrospective review of 4,767 consecutive spinal anesthetics performed at the Mayo Clinic, Rochester MN from June 1987 through June 1990, to evaluate modern spinal anesthesia practice. Mean patient age was 65 +/- 15 years, including 75% men and 25% women. Spinal needle gauges were predominately 22 ga (64%) 25 ga (21%) and 26-27-ga (12%). The most commonly used anesthetic was isobaric bupivacaine 0.75%, 24% and a mixture of procaine and tetracaine 33%.
Parestheisa during needle placement occurred in 6.3% of cases. Inadequate anesthesia was the most common complication, occurring in 2% of patients. The overall incidence of postdural puncture headache was 1.3%, including 0.48% who required an epidural blood patch. Persistent paresthesia, present on resolution of the block, occurred in 0.13% of patients; 4 of the 6 patients reported a paresthesia during needle placement, and elicitation of paresthesia significantly increased the risk of persistent symptoms.
Most persistent paresthesias resolved over 2-7 days; however, 1 patient's symptoms resolved slowly over 18 months. One paraspinal abscess and 1 disc space infection occurred, and both were treated with surgical drainage and antibiotics, and patients remained neurologically intact. These results are similar in previous reviews, and demonstrate the continued safety of spinal anesthesia.
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ABSTRACT
Serious neurologic complications rarely occur after spinal anesthesia. Historically, the reported frequency of persistent sensory or motor deficits has ranged from 0.005% to 0.7%. However, the introduction of small-gauge needles and new local anesthetics and intrathecal adjuvants makes it necessary to reevaluate the frequency of neurologic complications after spinal anesthesia. This study is a retrospective review of 4,767 consecutive spinal anesthetics performed between June 1987 and June 1990.
Mean patients age was 65 +/- 15 yrs. There were 3560 (74.7%) men and 1,207 (25.3%) women. A preexisting neurologic condition was present in 481 (10.1%) cases. The surgical procedures were genitourinary and lower extremity orthopedic in 4348 (91.2%) cases. A paresthesia was elicited during needle placement in 298 (6.3%) cases. Six patients reported pain upon resolution of the spinal anesthetic (persistent paresthesia). Four persistent paresthesias resolved within 1 wk; the remaining two resolved in 18-24 mo.
The presence of a paresthesia during needle placement significantly increased the risk of persistent paresthesia (P < 0.001). There, were also two infectious complications. One patient with recent (treated) urosepsis underwent a urologic procedure under spinal anesthesia and subsequently developed a disc space infection. The second patient developed a paraspinal abscess. Both were treated with surgical drainage and antibiotics and remained neurologically intact.
There were 62 (1.3%) patients with a postdural puncture headache, including 23 (0.5%) who underwent an epidural blood patch. These results are similar to those of previously published reviews and demonstrate the continued safety of spinal anesthesia.
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