Cauda equina syndrome following an uneventful spinal anesthesia in a patient undergoing drainage of the Bartholin abscess

Merino-Urrutia, Waldo; Villagrán-Schmidt, Milca; Ulloa-Vásquez, Priscilla; Carrasco-Moyano, Rubén; Stoicea, Nicoleta; Bergese, Sergio D.

doi:10.1097/md.0000000000010693

Cited by 16 publications

(10 citation statements)

References 10 publications

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“…The motor block is indeed the main obstacle to early discharge, hindering the ability of ambulation and the restoration of the spontaneous urinary function [26,27]. The assessment of the upper and lower limit sensory block has highlighted the tendence of the block to be confined in the chose dermatomer in the patients included in PF group, treated with Fentanyl-Prilocaine combination, unlike patients included in P group, treated only with Prilocaine, in which the anesthetic tends to spread in craniocaudal side more rapidly.…”

Section: Discussionmentioning

confidence: 99%

Tailored surgery in inguinal hernia repair. The role of subarachnoid anesthesia: a retrospective study

et al. 2019

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AbstractSafety and effectiveness evaluation of subarachnoid anesthesia implemented with hyperbaric Prilocaine in reduced dose (30mg) in combination with Fentanyl (20mcg), for the purpose of ensuring an optimal analgesia in open inguinal hernia repair.Although the local anesthesia is the first line treatment for open inguinal hernia repair, a minority of patients is not eligible because of obesity or big groin hernia, requiring a high dose of local anesthetic. Subarachnoid anesthesia implemented with hyperbaric Prilocaine in reduced dose in combination with Fentanyl may be a good alternative.Thirty patients were treated with intrathecal association of Prilocaine 30 mg and Fentanyl 20 mcg (group PF); they were compared to a group of fifty three ones, previously treated with a classic procedure with intrathecal Prilocaine 60 mg (group P).The sensitive blockage remained within an higher limit at T12 level in the patients of PF group, and a lower limit at S1 level 50 minutes after the anesthesia, while in the P group the anesthetic tended to migrate (p<0.0001). In PF group 70 minutes after the anesthesia 21 patients had a Bromage score equal to 0 and 9 patients equal to 9 (in P group, 19 patients had a score equal to 3, 8 to 2 and 3 to 1, p<0.0001).Subarachnoid anesthesia using Prilocaine 30 mg + Fentanyl 20 mcg could be stated as a viable alternative to local anesthesia in selected patients.

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Section: Discussionmentioning

confidence: 99%

Tailored surgery in inguinal hernia repair. The role of subarachnoid anesthesia: a retrospective study

et al. 2019

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“…In summary, CES (Carron, Behr, & Ori, 2013; Chabbouh et al, 2005; Merino‐Urrutia et al, 2018; Moussa et al, 2006; Ozgen, Baykan, Dogan, Konya, & Pamir, 2004; Shields, Iyer, Zhang, & Shields, 2018; Takasu et al, 2010; Vianna et al, 2001) and transient radicular irritation syndrome (TNS) (Al‐Nasser, Negre, & Hubert, 2002; Evron et al, 2007; Salazar, Bogdanovich, Adalia, Chabás, & Gomar, 2001; Ya‐Deau, Liguori, & Zayas, 2005; Zaric, Christiansen, Pace, & Punjasawadwong, 2005) are rare but still prevalent complications of spinal subarachnoid block, and their exact cause remains unclear. All previously proposed hypotheses have been losing support, and the effects have been described as occurring with most LA agents: lidocaine (Gerancher, 1997; Loo & Irestedt, 1999; Newman et al, 1997; Salmela, Aromaa, & Cozanitis, 1996; Schneider et al, 1993; Tarkkila et al, 1995), tetracaine (Sumi et al, 1996; Vianna et al, 2001), isobaric bupivacaine (Moussa et al, 2006; Tarkkila et al, 1996), hyperbaric bupivacaine (Chabbouh et al, 2005; Keld, Hein, Dalgaard, Krogh, & Rodt, 2000), levobupivacaine (Carron et al, 2013), mepivacaine (Liguori et al, 1998; Salazar et al, 2001; Ya‐Deau et al, 2005), ropivacaine (Al‐Nasser et al, 2002; Ganapathy, Sandhu, Stockall, & Hurley, 2000), and prilocaine (Martínez‐Bourio et al, 1998).…”

Section: Discussionmentioning

confidence: 99%

Spinal arachnoid sleeves and their possible causative role in cauda equina syndrome and transient radicular irritation syndrome

Riquelme¹,

Reina

Boezaart

et al. 2021

Clinical Anatomy

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Introduction We have previously described arachnoid sleeves around cauda equina nerve roots, but at that time we did not determine whether injections could be performed within those sleeves. The purpose of this observational study was to establish whether the entire distal orifice of a spinal needle can be accommodated within an arachnoid sleeve. Materials and methods We carefully dissected the entire dural sacs off four fresh cadavers, opened them by longitudinal incision, and immersed them in saline. Under direct vision, we penetrated the cauda equina roots nerves traveling almost vertically downward at 30 locations each with a 27‐ and a 25‐G pencil‐point needle (60 punctures total). We captured the images with a stereoscopic camera. Results The nerve root offered no noticeable resistance to needle entry. Although the arachnoid sleeves could not be identified with the naked eye, they were translucent but visible under microscopy. In 21 of 30 attempts with a 27‐gauge needle, and in 20 of 30 attempts with a 25‐gauge needle, the distal orifice of the spinal needle was completely within the arachnoid sleeve. Conclusion It seems possible to accommodate the distal orifice of a 25‐ or a 27‐gauge pencil‐point spinal needle completely within the space of the arachnoid sleeve. An injection within this sleeve could potentially lead to a neurological syndrome, as we have previously proposed.

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“…Cauda equina syndrome is a rare but an extremely distressing complication of spinal-epidural anesthesia. [ 19 – 21 ] Most neurological complications are caused by epidural hematoma, abscess, catheter trauma, infection, and anesthetic toxicity. In the patient, the MRI revealed no hematoma, abscess, infarction, spinal stenosis, or lumbar disc herniation.…”

Section: Discussionmentioning

confidence: 99%

Vocal fold paralysis and cauda equina syndrome following spinal-epidural anesthesia

et al. 2021

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Rationale: Vocal fold paralysis and cauda equina syndrome are very rare neurologic deficits. This report describes the case of a patient who simultaneously developed both after uneventful spinal-epidural anesthesia with 0.5% hyperbaric bupivacaine. Patient concerns: We report the case of a 45-year-old female, who underwent surgery for bilateral hallux valgus developed cauda equina syndrome and unilateral vocal fold paralysis after uneventful spinal-epidural anesthesia was administered. There was no pain or paresthesia during needle placement or drug injection. Surgery was performed uneventfully. Diagnoses: Right vocal fold paralysis was diagnosed with flexible laryngoscopy. Interventions: Patient was started on the treatment with a surgery for bilateral hallux valgus, who developed cauda equina syndrome and unilateral vocal fold paralysis after uneventful spinal-epidural anesthesia was administered. Outcomes: Postoperatively, she had difficulty in urination and defecation. In addition, she developed unilateral vocal fold paralysis characterized by hoarseness, effortful voice production, and choking with liquids. Magnetic resonance imaging performed on the lumbosacral area and computed tomography of the neck, the chest, and the skull revealed entirely normal results. However, flexible laryngoscopy revealed a right vocal fold paralysis. Although cauda equina syndrome can occur due to neurotoxicity of local anesthetics, the exact etiology of vocal fold paralysis is uncertain. Lessons: The case highlights that 2 rare and serious complications of spinal-epidural anesthesia can even occur in the same patient after uneventful surgery and block performance.

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Cauda equina syndrome following an uneventful spinal anesthesia in a patient undergoing drainage of the Bartholin abscess

Cited by 16 publications

References 10 publications

Tailored surgery in inguinal hernia repair. The role of subarachnoid anesthesia: a retrospective study

Tailored surgery in inguinal hernia repair. The role of subarachnoid anesthesia: a retrospective study

Spinal arachnoid sleeves and their possible causative role in cauda equina syndrome and transient radicular irritation syndrome

Vocal fold paralysis and cauda equina syndrome following spinal-epidural anesthesia

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