Neurologic Complications Following Spinal Anesthesia with Lidocaine

Phillips, Otto C.; Ebner, H; Nelson, Alfred T.; Black, Milton H.

doi:10.1097/00000542-196903000-00011

Cited by 178 publications

(34 citation statements)

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“…The use of smaller gauge Quincke needles or pencil-point needles such as the 25-gauge Whitacre may result in less postdural puncture headache. However, despite the young age group and early ambulation, our 4% incidence of postdural puncture headache is comparable to the 3.5% incidence reported by Phillips et al 16 from a large series using mainly 25-gauge or 26-gauge spinal needles and lower than the 7.5% incidence reported following the use of 26-gauge Quincke needles in day-care surgery. ~7 The overall incidence of postoperative backache has been reported to be approximately 20% and appears to be primarily related to the duration of surgery with no difference in frequency following general anaesthesia or spinal anaesthesia.…”

Section: Discussionsupporting

confidence: 71%

Dose response study of lidocaine 1% for spinal anaesthesia for lower limb and perineal surgery

1998

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Purpose: To compare the sensory and motor block produced by three different volumes of intrathecal lidocaine 1% and thereby determine the appropriate volume to administer for surgery of the lower limbs and perineum. Methods: Forty-eight patients scheduled for perineal or lower limb surgery were randomly assigned to receive 4, 6 or 8 ml lidocaine I ~ intrathecally. The onset, spread, duration and regression of analgesia and motor block and side effects were evaluated (by a blinded observer whenever possible). Results: The maximum cephalad spread in the 6 ml CI-8 _ 3) and 8 ml (T 4 _+ 1.7) groups were higher than the 4 ml group (-i-,2 +_ 2.2, P < 0.01 ). In the 4 ml group, six patients (33%) did not achieve analgesia to T,2 and four (22%) did not have complete motor blockade. Patients given 8 ml had longer duration of block (duration at T~2: 104 _ 23 vs 60 -+ 24, 67 -+ 14 min, P < 0.01 ; 8 ml vs 4, 6 ml) and slower recovery times (sensory recovery: 188 -+ 27 vs 142 _+ 27, 157 _+ 28 min, P < 0.01; 8 ml vs 4, 6 ml). Two patients (I 8%) from the 8 ml group and one (5%) from the 6 ml group had transient hypotension. Conclusion: Four millilitres intrathecal lidocaine I% is adequate for perineal surgery but for lower limb procedures, 6 ml is more appropriate as it consistently provides sensory analgesia above L, dermatome and complete motor block. Eight ml gives an unnecessarily high block with higher incidence of hypotension.

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Section: Discussionsupporting

confidence: 71%

Dose response study of lidocaine 1% for spinal anaesthesia for lower limb and perineal surgery

1998

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“…Lange Zeit galt Lidocain als nebenwirkungsarmes Lokalanästhetikum und wurde v. a. für kürzere Operationen verwendet. Eine Sicherheitsevaluation von Lidocain an 10.440 Patienten, deren Daten allerdings erst 1969 publiziert wurden, ergab bei immerhin 284 (2,7%) Patienten unerklärbare Rückenschmerzen, die bei 91 Patienten derart stark und anhaltend waren, dass diese weitere SPA verweigerten [30].…”

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Transiente neurologische Symptome nach Spinalanästhesie Eine quantitative systematische Übersicht (Metaanalyse) randomisierter kontrollierter Studien

et al. 2002

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“…[16][17] According to several large studies published at least 20 yr ago, the reported frequency of persistent sensory and motor deficits following spinal anesthesia in approximately 50,000 patients ranged from 0.005% to 0.7%. [18][19][20] Over the years, this safety record of spinal anesthesia has not changed, with reported incidences of 0.08% to 0.12% according to three recent large studies involving more than 50,000 patients. 8,10,11 Similarly, neurological complications following epidural anesthesia, as reviewed by Dawkins three decades ago, are uncommon.…”

Section: Neuraxial Blocksmentioning

confidence: 99%

Litigation in Canada against anesthesiologists practicing regional anesthesia. A review of closed claims

Peng

Smedstad

2000

Can J Anesth/J Can Anesth

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Purpose: To review the pattern of malpractice litigation related to regional anesthesia in Canada. Source: The Canadian Medical Protective Association (CMPA) provided with information about all anesthesia claims that closed in the years 1990-1997.Principal Findings: In the period 1990-97 there were 7,909 closed legal actions involving all CMPA members (56,000). Of these, there were 310 cases involving anesthesiologists, of which 61 cases (approximately 20%) were related to regional anesthesia. Forty-two involved neuraxial blocks, and the legal outcome was favourable (dismissed or judgement in favour of the defendant doctor) in 37 claims. Nineteen claims involved peripheral nerve blocks. All these had favourable legal outcomes. Overall, 10% of regional anesthesia claims have unfavourable outcomes, compared with 28% of all anesthesia related claims and 30% of all CMPA members' claims. The degree of disability in the regional anesthesia claims were: none 10%; minor 49%; major 36%; catastrophic 5%. There were no deaths in the malpractice claims involving regional anesthesia, compared with 17% in the all anesthesia group and 11% in all members' claims. Conclusion:Twenty percent of all anesthesia claims in Canada are related to regional anesthesia. The legal outcome of these claims is favourable in 90%. Unfavourable clinical outcome is associated with catastrophic or major injury. There were no deaths in the regional anesthesia claims.Objectif : Revoir les accusations pour faute professionnelle concernant l'anesthésie régionale au Canada. Source : L'Association canadienne de protection médicale (ACPM) a fourni les renseignements au sujet de toutes les réclamations réglées de 1990 à 1997 qui concernaient l'anesthésie.Constatations principales : De 1990 à 1997 il y a eu 7 909 poursuites judiciaires réglées qui impliquaient des membres de l'ACPM (56 000). De ce nombre, 61 cas étaient liés à l'anesthésie régionale, donc environ 20 % des 310 cas touchant des anesthésiologistes. Dans 42 cas, il s'agissait de blocs neuraxiaux et l'issue de la poursuite a été favorable (action rejetée ou jugement en faveur du médecin accusé) dans 37 cas. Dans 19 cas, c'était des blocs nerveux périphériques. Toutes ces poursuites ont été favorables aux médecins. Globalement, 10 % des réclamations liées à l'anesthésie régionale ont été défavorables contre 28 % de toutes les réclamations anesthésiques et 30 % de celles des membres de l'ACPM. Le degré d'invalidité concernant l'anesthésie régionale ont été : aucun, 10 %; mineur, 49 %; majeur, 36 %; catastrophique, 5 %. Aucun décès n'est lié aux poursuites pour faute professionnelle dans des cas d'anesthésie régionale, à comparer à 17 % dans tous les groupes d'anesthésie et 11 % des réclamations parmi tous les membres. Conclusion :De toutes les réclamations concernant l'anesthésie au Canada, 20 % sont reliées à l'anesthésie régionale. L'issue de ces poursuites est favorable aux médecins dans 90 % des cas. Des résultats cliniques défa-vorables sont liés à des lésions catastrophiques ou majeures. Auc...

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Neurologic Complications Following Spinal Anesthesia with Lidocaine

Cited by 178 publications

References 0 publications

Dose response study of lidocaine 1% for spinal anaesthesia for lower limb and perineal surgery

Dose response study of lidocaine 1% for spinal anaesthesia for lower limb and perineal surgery

Transiente neurologische Symptome nach Spinalanästhesie Eine quantitative systematische Übersicht (Metaanalyse) randomisierter kontrollierter Studien

Litigation in Canada against anesthesiologists practicing regional anesthesia. A review of closed claims

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