Paralysis of the bladder and associated neurological sequelæ of spinal anæsthesia (cauda equina syndrome)

Abstract

THE excellent results which are obtained from the use of spinal anaesthesia may be judged from its popularity in practice. From time to time, however, there have appeared in the literature reports of patients who have developed neurological complications-varying from headache, meningism, cranial nerve paralyses, and focal cerebral lesions to radiculomyelitis, cauda equina, and peripheral nerve lesionsoccurring immediately after or remotely following the administration of a spinal anaesthetic. The statements in the literature are extremely contradictory as to the frequency with which such nervous sequelae occur. Jarman14 gives the incidence of paralysis as one in ten thousand cases. Foss and Schwalm12 stated that they had never seen the slightest evidence of peripheral neuritis or sensory or motor disturbance following three thousand spinal anaesthetic administrations. They had never seen a case of foot-drop or had patients who suffered from pain in the body or in the legs following anaesthesia. These authors quote Lundy as never having noticed at the Mayo Clinic that sterile procaine hydrochloride administered by the usual technique and in safe doses produced any serious changes in the spinal cord. Lundy, Essex, and KernohanYz0 however, stated that they had observed a case of (' temporary paralysis " from the use of 10 per cent procaine.On the other hand, Hyslop13 reported neurological sequelae in 11 of 2074 cases recorded by various writers ; and 7 examples of neurological complications were reported by Brock, Bell, and Davison.' There is no doubt about the frequency with which severe and continued headache and also sixth-nerve paralysis occur. Indeed, BlattY5 in 1929, collected over roo cases of the latter following spinal anaesthesia. Loeserl9 believed that an inflammatory syndrome affecting isolated peripheral nerves was more frequent than was realized, having encountered 5 cases in one year. A review of the literature and the personal experiences recorded by Macdonald Critchley8 suggest that neurological complications occur much more frequently than is commonly supposed.In this paper are recorded 14 cases which developed a cauda equina syndrome following the administration of a spinal anaesthetic. Thirteen of these cases occurred within a period of twenty months. Only sixteen examples of this lesion were found in an examination of the literature before this period.This report is published not with the intention of disparaging a very valuable, if not indispensable, form of anaesthesia, but in the hope that the result of these

Cocaine Increases the Intracellular Calcium Concentration in Brain Independently of Its Cerebrovascular Effects

“…It has been known for decades that local anesthetics have the potential to permanently damage the spinal cord (Ferguson and Watkins, 1937;Macdonald and Watkins, 1937); however, the mechanism behind their neurotoxic action is still unresolved. Our study demonstrates for the first time in vivo that a local anesthetic (lidocaine) causes [Ca 2ϩ ] i increases in the brain that may explain its potential neurotoxicity, especially when local anesthetics are combined with vasoactive agents such as epinephrine, which is often administered in conjunction with the local anesthetic when used clinically.…”

Complicações neurológicas determinadas pela anestesia subaracnóidea

“…Dentre os fatores potencialmente capazes de desencadeá-la encontram-se o trauma direto ou indireto das raízes nervosas, a isquemia, a infecção e as reações neurológicas 9 . Enfoque particular é atribuído aos efeitos neurotóxicos dos anestésicos locais, já descritos na primeira metade do sécu-lo passado [52][53][54] , porque a síndrome da cauda eqüina reapareceu em 1991, agora ligada à raquianestesia com a técnica contínua, pela qual se administrou lidocaína a 5% em solução de glicose a 7,5%, através de microcatéteres 9, 55 . Nestes casos, as doses do anestésico local foram mais elevadas que aquelas usualmente empregadas com injeção única e tiveram por finalidade aumentar a extensão de um bloqueio predominantemente sacral 9 .…”

“…Direct or indirect nerve root trauma, ischemia, infection and neurological reactions are among potential cauda equina syndrome triggering factors 9 . Special attention is given to local anesthetics neurotoxic effects already described during the first half of last century [52][53][54] , because cauda equina syndrome has reappeared in 1991, now related to continuous spinal anesthesia with 5% lidocaine in 7.5% glucose through microcatheters 9, 55 . In those cases, local anesthetic doses were higher than those usually used in single injection and were aimed at increasing the extension of a predominantly sacral blockade 9 .…”

Use of Spinal Analgesia in Forceps and Breech Deliveries

“…It is difficult to assess the incidence of these complications since reports are so varied. The clinical picture is described by Macdonald Critchley (1937) andFerguson and. In cauda equina syndrome there is loss of sensation over the sacrum and coccyx, anal incontinence, and retention of urine.…”