Bilateral Frontal Haemorrhages Associated with Continuous Spinal Analgesia

Crofts, Tyron; Monagle, John; Buist, Michael; Burnes, James

doi:10.1177/0310057x0102900110

Anaesth Intensive Care

2001

DOI: 10.1177/0310057x0102900110

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Bilateral Frontal Haemorrhages Associated with Continuous Spinal Analgesia

Tyron Crofts

John Monagle

Michael Buist

et al.

Abstract: We report a case of intracerebral haemorrhages associated with continuous spinal analgesia. Continuous spinal analgesia is frequently employed for postoperative analgesia in high-risk patients in our institution. The analgesia is administered via a 20 gauge catheter passed through an 18 gauge Tuohy needle (Portex). A 71-year-old man with severe respiratory impairment had an intrathecal catheter placed for postoperative analgesia. He had a difficult postoperative course, including wound dehiscence, and died fro… Show more

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Cited by 6 publications

References 13 publications

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Intracerebral hematoma after combined spinal-epidural anesthesia: Complication or coincidence?

Albaladéjo¹,

Geffroy²,

Faillot³

et al. 2005

Can J Anesth/J Can Anesth

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tive audit of 1,000 ankle blocks for mid or forefoot surgery. Aims were to determine block success rate, risk factors for block failure and length of action of differing combinations of local anesthetic (LA). The choice of LA was either a 50/50 mixture of lidocaine 1.5% plain and ropivacaine 7.5 mg·mL -1 , ropivacaine 7.5 mg·mL -1 alone, or ropivacaine 7.5 mg·mL -1 and clonidine 1 µg·kg -1. A standardized ankle block technique was used using a 40 mL total maximum volume with optional sedation for block and surgery. Using a 25 gauge 35-mm needle, the tibial nerve was blocked with up to 10 mL LA at the medial malleolar level, posterior to the posterior tibial artery pulsation. The saphenous and superficial peroneal nerves were blocked by infiltration of 10 to 15 mL LA along a line joining both malleoli and the sural nerve with up to 10 mL LA infiltrated 1.5 cm distal to the tip of the fibula. The deep peroneal nerve were blocked at the malleolar level, with up to 5 mL LA between bone and skin (both sides of the dorsalis pedis pulsation). A 15-cm wide low-pressure ankle tourniquet (Zimmer, Warsaw, Indiana) was applied at the supramalleolar level and inflated to a pressure of 250 mmHg for surgery. A successful block was defined as one that did not require surgical supplementation, iv sedation or general anesthesia (GA) for surgery.Overall block success rate was 94.7%, with a 4.4% improvement over the last 700 cases. The failure rate when surgery commenced before 20 min from block insertion was significantly (P < 0.001) greater than for longer waiting periods; there was a sharp drop in failure as waiting periods increased (Figure). Nine patients required GA (3 tourniquet pain, 2 block failures, 3 anxiety, 1 confused). Ropivacaine with clonidine had a significantly longer mean duration of action at 15.9 hr compared to other LA agents (P < 0.001).In conclusion, compared to popliteal block, our ankle block audit demonstrated a high success rate, with a longer period of analgesia with the addition of clonidine.2-4 Few patients (0.2%) required GA for block failure. LA supplementation and sedation is required more often with surgery commencing within 20 min. Time constraints may be a major impediment for clinicians performing ankle blocks, as recognized in work published recently.

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Intracerebral hematoma after combined spinal-epidural anesthesia: Complication or coincidence?

Albaladéjo¹,

Geffroy²,

Faillot³

et al. 2005

Can J Anesth/J Can Anesth

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Intrazerebrale Blutung nach Sectio ceasarea in Spinalanästhesie

Knobelsdorff

Paris

2004

Anaesthesist

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Intracerebral haemorrhage is a rare complication of spinal anaesthesia in obstetrics. A 37-year-old woman without any accompanying disease during a twin pregnancy, underwent an urgent caesarean section due to insufficiency of the placenta under spinal anaesthesia using hyperbaric bupivacain (0.5%) and a pencil-point spinal needle Sprotte 27 Gauge. The patient developed severe headache, a hemiparesis of the right upper limb and became somnolent and finally unconscious 80 min after the procedure. An immediately performed computed tomographic scan revealed a large acute intracerebral haemorrhage in the left hemisphere region with mass effect. The patient underwent temporoparietal craniotomy. No obvious cause of the haemorrhage, such as aneurysm or arteriovenous malformation was found. The patient fully recovered and was weaned from the respirator 32 h postoperatively. On postoperative day 7 the remaining neurologic deficits included aphasis and severe hemiparesis of the right upper limb and a right extensor plantar response. The neurologic status did not improve substantially until 6 months after the complication. The case and the recent literature are discussed.

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Encapsulation of an intrathecal catheter

Gaertner

Sabatowski²,

Elsner³

et al. 2003

Pain

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A 47-year-old patient with cancer pain underwent implantation of an intrathecal drug delivery device. When the patient suffered from an infection with fever, pain on injection into the catheter and an elevated number of granulocytes in the cerebrospinal fluid 7 weeks later, radiologic examination showed an encapsulation of the catheter tip. Concentrations of morphine and morphine-6-glucuronide in the cerebrospinal fluid suggested transport of morphine into the systemic circulation via the vascularisation of the encapsulating membrane. After antibiotic therapy and removal of the catheter, morphine was administered intravenously with a one to one conversion ratio.

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Bilateral Frontal Haemorrhages Associated with Continuous Spinal Analgesia

Cited by 6 publications

References 13 publications

Intracerebral hematoma after combined spinal-epidural anesthesia: Complication or coincidence?

Intracerebral hematoma after combined spinal-epidural anesthesia: Complication or coincidence?

Intrazerebrale Blutung nach Sectio ceasarea in Spinalanästhesie

Encapsulation of an intrathecal catheter

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