Transient neurological manifestations after epidural analgesia with ropivacaine

Al-Nasser, Bassam; Négre, M.; Hubert, Cédric

doi:10.1111/j.1365-2044.2002.2520_35.x

Cited by 19 publications

(5 citation statements)

References 6 publications

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“…Ropivacaine was reported to result in CES after epidural anesthesia [11]. Epidural injection could result in cystic accumulation of injected local anesthetics [2].…”

Section: Discussionmentioning

confidence: 99%

Tarlov cyst with self-healing cauda equina syndrome following combined spinal-epidural anesthesia: a case report

Chen

Lin

2023

Preprint

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Background Cauda Equina Syndrome (CES) after Combined Spinal-Epidural Anesthesia(CSEA) is a rare disease that most of the time need surgery to relieve spinal cord compression. Case Presentation A 34-year-old male patient underwent a procedure for prolapse and hemorrhoids (PPH) under CSEA. Anesthesia and surgery were uneventful. However, the patient gradually experienced urinary retention, lower abdomen and back pain, changes in bowel habits and neurological dysfunction of the lower limbs when the catheter was removed. It was later determined that the patient had Tarlov cyst at the left S1 level in the sacral canal. Finally, the patient completely recovered 20 days after drug conservative therapy onset. Conclusion This case suggests that CES might occur even after ordinary CSEA. The risk factors are drug neurotoxicity to ropivacaine and Tarlov cyst, which helped to accumulate ropivacaine. The development of ultrasound-guided CSEA and an ultrasound atlas of the spinal canal are required.

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“…Ropivacaine was reported to result in CES after epidural anesthesia [11]. Epidural injection could result in cystic accumulation of injected local anesthetics [2].…”

Section: Discussionmentioning

confidence: 99%

Tarlov cyst with self-healing cauda equina syndrome following combined spinal-epidural anesthesia: a case report

Chen

Lin

2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Another important risk factor for CES after uneventful CSEA is drug neurotoxicity of local anesthetics [ 10 ]. Ropivacaine was reported to result in CES after epidural anesthesia [ 11 ]. Epidural injection could result in cystic accumulation of injected local anesthetics [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Tarlov cyst with self-healing cauda equina syndrome following combined spinal-epidural anesthesia: a case report

Chen,

Lin

2023

BMC Anesthesiol

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Background Cauda Equina Syndrome (CES) after Combined Spinal-Epidural Anesthesia (CSEA) is a rare disease that most of the time need surgery to relieve spinal cord compression. Case presentation A 34-year-old male patient underwent a procedure for prolapse and hemorrhoids (PPH) under CSEA. Anesthesia and surgery were uneventful. However, the patient gradually experienced urinary retention, lower abdomen and back pain, changes in bowel habits and neurological dysfunction of the lower limbs when the catheter was removed. It was later determined that the patient had Tarlov cyst at the left S1 level in the sacral canal. Finally, the patient completely recovered 20 days after drug conservative therapy onset. Conclusion This case suggests that CES might occur even after ordinary CSEA. The risk factors are drug neurotoxicity to ropivacaine and Tarlov cyst, which helped to accumulate ropivacaine. The development of ultrasound-guided CSEA and an ultrasound atlas of the spinal canal are required.

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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). Hyperosmolarity (Ganapathy et al, 2000; Hampl, Schneider, Thorin, et al, 1995; Hampl, Schneider, Ummenhofer, & Drewe, 1995) has not been shown to be causal, and the use of more dilute concentrations did not prevent this complication (Arndt & Downey, 2002; Evron et al, 2007; Hampl et al, 1996; Pollock, Liu, Neal, & Stephenson, 1999; Sakura, Chan, Ciriales, & Drassner, 1995; Salazar et al, 2001).…”

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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Transient neurological manifestations after epidural analgesia with ropivacaine

Cited by 19 publications

References 6 publications

Tarlov cyst with self-healing cauda equina syndrome following combined spinal-epidural anesthesia: a case report

Tarlov cyst with self-healing cauda equina syndrome following combined spinal-epidural anesthesia: a case report

Tarlov cyst with self-healing cauda equina syndrome following combined spinal-epidural anesthesia: a case report

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

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