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Four cases of cauda equina syndrome occurring after continuous spinal anesthesia are reported. In all four cases, there was evidence of a focal sensory block and, to achieve adequate analgesia, a dose of local anesthetic was given that was greater than that usually administered with a single-injection technique. We postulate that the combination of maldistribution and a relatively high dose of local anesthetic resulted in neurotoxic injury. Suggestions that may reduce the potential for neurotoxicity are discussed. Use of a lower concentration and a "ceiling" or maximum dose of local anesthetic to establish the block should be considered. If maldistribution of local anesthetic is suspected (as indicated by a focal sensory block), the use of maneuvers to increase the spread of local anesthetic is recommended. If such maneuvers prove unsuccessful, the technique should be abandoned.
M L Rigler, and
K Drasner, and
T C Krejcie, and
S J Yelich, and
F T Scholnick, and
J DeFontes, and
D Bohner
June 1991,
Anesthesia and analgesia,
M L Rigler, and
K Drasner, and
T C Krejcie, and
S J Yelich, and
F T Scholnick, and
J DeFontes, and
D Bohner
January 1993,
Anesthesiology,
M L Rigler, and
K Drasner, and
T C Krejcie, and
S J Yelich, and
F T Scholnick, and
J DeFontes, and
D Bohner
June 2004,
Neurosurgical focus,
M L Rigler, and
K Drasner, and
T C Krejcie, and
S J Yelich, and
F T Scholnick, and
J DeFontes, and
D Bohner
April 2009,
Korean journal of anesthesiology,
M L Rigler, and
K Drasner, and
T C Krejcie, and
S J Yelich, and
F T Scholnick, and
J DeFontes, and
D Bohner
May 1995,
Anaesthesia,
M L Rigler, and
K Drasner, and
T C Krejcie, and
S J Yelich, and
F T Scholnick, and
J DeFontes, and
D Bohner
January 1992,
Regional anesthesia,
M L Rigler, and
K Drasner, and
T C Krejcie, and
S J Yelich, and
F T Scholnick, and
J DeFontes, and
D Bohner
January 2015,
Saudi journal of anaesthesia,
M L Rigler, and
K Drasner, and
T C Krejcie, and
S J Yelich, and
F T Scholnick, and
J DeFontes, and
D Bohner
February 1998,
Journal of clinical anesthesia,
M L Rigler, and
K Drasner, and
T C Krejcie, and
S J Yelich, and
F T Scholnick, and
J DeFontes, and
D Bohner
January 2001,
Revista espanola de anestesiologia y reanimacion,
M L Rigler, and
K Drasner, and
T C Krejcie, and
S J Yelich, and
F T Scholnick, and
J DeFontes, and
D Bohner
June 2006,
Anesthesia and analgesia,
