Transient Radicular Irritation After Spinal Anaesthesia with Hyperbaric 5% Lignocaine

Tarkkila, P.; Huhtala, J.; Tuominen, M.

doi:10.1097/00132586-199602000-00040

Cited by 30 publications

(47 citation statements)

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“…In the literature, the overall incidence of transient neurological symptoms after spinal anaesthesia using lidocaine has been reported to range from 10% to 37% [2][3][4][5] and the overall incidence of 25% found by us fits in this range. The variability in the incidence following lidocaine spinal anaesthesia may be explained by lack of standardization in definition by different authors.…”

Section: Discussionsupporting

confidence: 48%

“…This difference was not significant. Most patients rated the pain as moderate to severe, median (range) verbal rating scores were 5 (2-8) and 7 (1)(2)(3)(4)(5)(6)(7)(8) in Groups 1 and 2, respectively. The duration of symptoms was generally short and in all patients the symptoms resolved completely without sequelae within 24 h. Two patients, both in Group 2, had signs of postdural puncture headache.…”

Section: Resultsmentioning

confidence: 99%

“…Due to this the expression 'transient neurological symptoms' is presently used, although the term 'neurological' is also controversial, as the discomfort may be myofascial in origin. In previous studies, the incidence of these transient neurological symptoms following spinal anaesthesia has been reported to range from 10% to 37% [2][3][4][5].…”

mentioning

confidence: 96%

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Transient neurological symptoms with subarachnoid lidocaine: effect of early mobilization

et al. 2005

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Section: Discussionsupporting

confidence: 48%

Section: Resultsmentioning

confidence: 99%

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Transient neurological symptoms with subarachnoid lidocaine: effect of early mobilization

et al. 2005

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“…In 3 Studien wurde der Einfluss von Glukose als Adjuvans zum Lokalanästheti-kum untersucht, d. h. isobarem gegenüber hyperbarem Lokalanästhetikum [9, 35,40]. Dabei zeigen die gepoolten Resultate, dass die Dichte des Lokalanästhetikum keine signifikanten Auswirkung auf die TNS-Inzidenz hat (isobar: 8/169 vs. hyperbar: 13/165).…”

Section: Hat Die Dichte Des Lokalanästhetikums Einen Einfluss Auf Dieunclassified

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

et al. 2002

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“…Demnach können grundsätzlich sämtliche intrathekal applizierten Lokalanästhetika TNS auslösen; hierbei unterscheiden sich die substanzspezifischen Häufigkeiten z.T.erheblich.So gehen Lidocain und höchstwahrschein-lich auch Mepivacain mit den höchsten TNS-Inzidenzen einher (bis zu 37%); dagegen ist das Auftreten dieser Symptomatik nach intrathekaler Applikaltion von Procain und Tetracain seltener zu beobachten. Bupivacain und Prilocain gelten nach heutigem Wissensstand als die "sichersten" Substanzen hinsichtlich des Auftretens von TNS [89,90,135,180,201,230,239].Transiente neurologische Symptome können ebenfalls nach der Applikation von Ropivacain auftreten; die Inzidenz bleibt derzeit jedoch noch unklar [4].…”

Section: Neurotoxizitätunclassified

Toxikologie der Lokalan�sthetika

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Graf

2003

Der Anaesthesist

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Regardless of their specific physico-chemical properties and chemical structures, all local anaesthetic agents block neuronal voltage-gated sodium channels, and thus suppress conduction in peripheral nerves. Since these ion channels ubiquitously appear in excitable membranes, systemic accumulation of local anaesthetic agents may affect the functional integrity of these structures. Clinically, local anaesthetic-induced systemic toxicity results in central nervous and cardiovascular malfunction. With regard to CNS toxicity, symptoms which are largely drug-independent appear in a characteristic biphasic sequence. Nevertheless, the plasma levels necessary to provoke these symptoms are to a large extent agent-specific. Initially, these toxic mechanisms are due to a selective blockade of cortical inhibitory neurons, which enables the formation of seizure potentials within subcortical structures. With high cerebral drug levels, however, excitatory neurons are also increasingly blocked, resulting in coma, apnoeic episodes and circulatory failure. Direct cardiac effects of local anaesthetics can be divided into (i) stereospecific inhibition of intracardial conduction and (ii) unspecific inhibition of myocardial energy supply and ion channels. The corresponding spectrum of symptoms is not uniform and may range from extreme bradycardia, (malignant) ventricular arrhythmia to refractory cardiac arrest. Local tissue toxicity has to be strictly delimited from systemic toxicity and allergies, respectively, which are mainly caused by aminoester agents. Local anaesthetics may cause neuronal and striated muscle injury at the site of injection. With regard to (central) neurotoxicity, "transient neurologic symptoms" and "cauda equina syndrome" have been increasingly recognised. However, the clinical relevance of local anaesthetic-induced myotoxicity is still controversly discussed. In order to avoid systemic accumulation of local anaesthetic agents, several safety procedures have to be considered during the application of these drugs. The treatment of systemic toxicity is strictly dependent on the expression of symptoms. However, hypoxia and acidotic episodes must be avoided and must be treated aggressively.

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Transient Radicular Irritation After Spinal Anaesthesia with Hyperbaric 5% Lignocaine

Cited by 30 publications

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Transient neurological symptoms with subarachnoid lidocaine: effect of early mobilization

Transient neurological symptoms with subarachnoid lidocaine: effect of early mobilization

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

Toxikologie der Lokalan�sthetika

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