Serious Complications Related to Regional Anesthesia

Auroy, Yves; Narchi, P.; Messiah, Antoine; Litt, Lawrence; Rouvier, B.; Samii, Kamran

doi:10.1097/00000542-199709000-00005

Cited by 1,020 publications

(371 citation statements)

References 14 publications

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“…SA-related complications range from insignificant to life threatening. A large survey in France revealed that the incidence of serious spinal (and epidural) complications were relatively low (2). In this survey, among 40640 performed procedures, the most frequent serious complication was cardiac arrest (n=26), followed by radiculopathy (n=19), death (n=6) and cauda equina syndrome (n=5).…”

Section: Introductionmentioning

confidence: 82%

See 1 more Smart Citation

Thoracic Unilateral Spinal Cord Injury After Spinal Anaesthesia for Total Hip Replacement: Fate or Mistake?

Costa¹,

Romualdo²,

Eugenio³

et al. 2017

Turk J Anaesth Reanim

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Case Report / Olgu Sunumu Spinal anestezi total kalça protezi ameliyatı için ilk seçenektir ve hafif komplikasyonlarının yanı sıra yaşamı tehdit edecek kadar ciddi komplikasyonları da vardır. Bazı spinal kord iskemisi vakaları tanımlanmış olmasına rağmen, nöroaksiyal anestezi sonrasında nörolojik komplikasyonların insidansı net değildir. Bu çalışmada, total kalça protezi için L2-L3 spinal anestezi uygulamasının ardın-dan gelişen tek taraflı T8-T11 spinal kord iskemi vakası sunulmaktadır. Manyetik rezonans görüntülemesi (MRI) sonucunda, sol paramediyan spinal kord hiperintens T8-T11 sinyal değişikliği bulundu. Hasar ile cerrahi arasında geçici bir epidemiyolojik bağ-lantının varlığı görülmektedir. Yaralanma, yara alanı ile spinal iğ-nenin giriş alanı arasında, anatomik yakınlık olmaksızın meydana geldi. Bu durum, sadece birinin yaralanmayı tek başına belirlemek için yeterli olmayacağı birçok faktörden kaynaklanabilir. Aynı anda hepsinin etkisiyle komplikasyon oluşabilir. Çalışmamızda sonuç öngörülemez ve kaçınılmazdı. Yetersiz tıbbi uygulamadan ziyade beklenmeyen durumlar bu sonuca yol açtılar.Anahtar kelimeler: Spinal kord yaralanmaları, spinal anestezi, kalça protezi artroplastisi, spinal kord iskemisi, iskemik miyelopati Spinal anaesthesia is the most preffered anesthesia technique for total hip replacement, and its complications range from low entity (insignificant) to life threatening. The incidence of neurologic complications after neuraxial anaesthesia is not perfectly clear, although there are several described cases of spinal cord ischaemia. We present a case of unilateral T8-T11 spinal cord ischaemia following L2-L3 spinal anaesthesia for total hip replacement. Magnetic resonance imaging showed a hyperintense T8-T11 signal alteration on the leftside of paramedian spinal cord. A temporal epidemiologic linkage between the damage and the surgery seems to be present. The injury occurred without anatomical proximity between the injury site and the spinal needle entry site. This may be due to multiple contributing factors, each of them is probably not enough to determine the damage by itself; however, acting simultaneously, they could have been responsible for the complication. The result was unpredictable and unavoidable and was caused by unforeseeable circumstances and not by inadequate medical practice.Keywords: Spinal cord injuries, spinal anaesthesia, arthroplasty, hip replacement, spinal cord ischaemia, ischaemic myelopathy Abstract / Öz

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Section: Introductionmentioning

confidence: 82%

“…The incidence of neurological complications after neuraxial anaesthesia is not perfectly clear (0-0.08%) (2,4). Furthermore, spinal cord (SC) ischaemia is a rare event when compared to cerebral ischaemia.…”

Section: Introductionmentioning

confidence: 99%

Thoracic Unilateral Spinal Cord Injury After Spinal Anaesthesia for Total Hip Replacement: Fate or Mistake?

Costa¹,

Romualdo²,

Eugenio³

et al. 2017

Turk J Anaesth Reanim

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show abstract

“…A debilidade e defeitos sensoriais podem ser duradouros. 4 Recomendamos um breve exame neurológico dos membros inferiores antes de um protocolo de raquianestesia e, em uma situação de queda do pé relacionada à raquianestesia, um diagnóstico urgente é necessário e um processo de tratamento é fundamental para melhores resultados em longo prazo.…”

Section: Revistaunclassified

Queda do pé após raquianestesia

Aycan

Turgut²,

Güzel

et al. 2015

Brazilian Journal of Anesthesiology

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“…ultrasound imaging technology is expensive, subjective and operator-dependent 17 39 44 45. The incidence of permanent neurological damage after peripheral nerve block, a most feared complication of regional anaesthesia, has been quoted to be in the order of 1 : 5000–1 : 10 000 46 47. So, to show a significant difference in terms of nerve safety of ultrasound-guided nerve blocks, a very large study would be required 48…”

Section: Review Of Literaturementioning

confidence: 99%

Femoral nerve blocks in fractures of femur: variation in the current UK practice and a review of the literature

Mittal

Vermani

2013

Emerg Med J

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Fractures of the femur are common orthopaedic emergencies presenting to emergency departments (ED). Femoral nerve block (FNB) is a fast, safe and effective means of providing pain relief to these patients. With the aim to analysing the variation in current practice of giving FNB in patients with fractured femur in the UK, we carried out a telephonic national survey. Out of 252 EDs contacted, 230 departments participated in the survey (91% response rate). The survey showed that 74% EDs in the UK had access to ultrasound, but only 10% EDs gave FNB regularly under ultrasound guidance. In total, 46% of EDs gave FNB by blind technique. Therefore, ultrasound-guided FNB is an underutilised method of providing pain relief for fractured femur patients. The main reasons for not using ultrasound for FNB were: lack of training, participants' confidence in giving an effective and safe FNB block blindly and time constraints. The literature review suggests that ultrasound-guided FNB has a faster onset of action, is more effective and safer than the FNB given with nerve stimulator (NS) or blindly, and probably needs lower local anaesthetic dose. The use of NS for FNB in ED might not be practical because of the likelihood of the pain resulting from the movement of the affected limb due to the contraction of the muscles caused by nerve stimulation and because of additional training needed in using NS. The studies comparing FNB given using ultrasound or NS, or given blindly, have been done in the perioperative settings. To date, there has been no randomised controlled trial in ED setting comparing FNB given blindly or under ultrasound guidance. Such a study might have provided a good evidence for modifying the current practice of blind FNB.

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Serious Complications Related to Regional Anesthesia

Cited by 1,020 publications

References 14 publications

Thoracic Unilateral Spinal Cord Injury After Spinal Anaesthesia for Total Hip Replacement: Fate or Mistake?

Thoracic Unilateral Spinal Cord Injury After Spinal Anaesthesia for Total Hip Replacement: Fate or Mistake?

Queda do pé após raquianestesia

Femoral nerve blocks in fractures of femur: variation in the current UK practice and a review of the literature

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