Major neurological complications following central neuraxial blockade – A multicentre pilot study in Aurangabad city (MGMA CNB Study)

Abstract

Background and Aims: Incidence of major neurological complications following central neuraxial blockade (CNB) in India is not known. This information is essential for explaining risk preoperatively to patients and for medico-legal purposes. This study was undertaken to assess feasibility (recruitment process, protocol adherence, resources mobilisation, data management and evaluation of scientific outcome) for planning multicentric studies on major neurological complications following CNB at state/national level. Methods: This was a hospital-based, multicentre pilot study, with cross-sectional and follow-up components. Patients receiving CNB either perioperatively or during acute/chronic pain management were included in the study. Thirty-six randomly selected tertiary and nontertiary care institutes were included. Details of demographic information, CNB procedure and major neurological complications were collected anonymously via online tools. Feedback about study feasibility was collected from participating anaesthesiologists and study team. Results: Selected institutes continued participation throughout study period. About 99.98% of eligible patients were enroled. Complete data collection of 8053 patients and analysis was possible. Regular reminders from study coordinators helped to optimise data collection. Tertiary care institutes contributed to 74.50% of data. About 64.96% patients were females. Spinal anaesthesia was the most frequently used neuraxial block (93.41%). Bupivacaine and adjuvant were used in 95.53% and 16.5% patients, respectively. Two patients developed cardiac arrest and cause-effect relationship with CNB was established. Participants’ recruitment, protocol adherence, resources mobilisation, data management and evaluation of scientific outcomes were feasible. Conclusion: A multicentre state/nationwide study can be conducted based on this first-of-its-kind pilot study in India.

Foot drop – An unusual complication of epidural anaesthesia in a child

“…Foot drop is a well-recognised, although uncommon complication of spinal anaesthesia. [ 1 ] This complication is rarer still with epidural anaesthesia. [ 2 ] Interestingly, we found just a single report of foot drop as a complication of epidural anaesthesia in the paediatric age group.…”

Successful administration of unilateral spinal anaesthesia in a patient receiving dual anti-platelet therapy under platelet transfusion cover

“…Though spinal anaesthesia (SA) is commonly administered to patients with a history of cardiac disease including parturients in elective areas, the risk of development of paraplegia associated with the use of dual anti-platelet therapy (DAPT) limits its use in emergency situations. [ 1 2 3 ] Here, we share our experience of successful administration of SA for emergency lower limb surgery, in a patient receiving DAPT under platelet transfusion cover.…”

Allodynia in bilateral lower limbs after epidural catheter insertion

“…Neurological complications after regional anaesthesia are rare, ranging from 1:1000 to 1:100,000. [ 1 ] Allodynia is an even rarer complication of central neuraxial blockade, with only a few case reports in the literature. Here, we report a case of a patient who experienced allodynia in both the lower limbs after epidural catheter insertion.…”