Neurological complications following central neuraxial blocks: are there predictive factors?

Severe complications such as spinal epidural haematoma and an array of adverse neurological events leading to temporary or permanent disability have been ascribed to central neuraxial blocks. Infections (meningitis, abscesses), chemical injuries and very rarely cerebral ischaemia or haemorrhage, or both, have also been ascribed directly or indirectly to spinal and/or epidural anaesthesia. Some case reports, and very few retrospective studies, have focused their attention on the fact that central nerve blocks can cause, albeit rarely, permanent damage to the spinal cord or nerve roots, or both. The cause of this damage in many cases remains unclear. The attention of investigators and practitioners is focused both on understanding the causative mechanisms of such accidents and in identifying 'alarm events' that can arise during the administration of a central block, if any. We reviewed the international literature for the neurological complications of central neuraxial blocks to identify some events that, if they occurred during the block procedure, could be perceived as dangerous.

Mepivacaine: update on an evergreen local anaesthetic.

Many local anaesthetics are presently available for clinical use. The choice of a particular agent for a particular regional anaesthetic is based mainly on its clinical and pharmacological features. Besides these, safety of drugs and the knowledge of side effects associated with their use can play a major role, since serious complications can be related to local anaesthetics administration. Pharmacologic features of mepivacaine are: its amide structure (therefore it is not detoxified by circulating plasma esterases), its rapid metabolism, which take place into the liver, and its rapid excretion via the kidneys. Clinically, mepivacaine shows: short onset time, very close to lidocaine, intermediate duration and low toxicity. Mepivacaine can be therefore considered as a first choice agent for peripheral nerve blocks, particularly in high cardiac risk patients.

[Spinal or epidural anaesthesia for caesarean section? Compared opinions]. / Anestesia spinale o epidurale nel taglio cesareo? Opinioni a confronto.

Regional anaesthesia during caesarean section reduces mortality directly related to anaesthesia. Epidural anaesthesia is a good choice when an epidural anaesthesia was performed during labor. General anaesthesia is recommended only for emergency caesarean section and when regional anaesthesia is contraindicated. The Authors describe the reasons for choicing an epidural or a spinal block. Main points supporting spinal block are facility in performing, quickness of the achievement of the block and a good quality of sensorial and motor block. On the other side epidural anaesthesia makes the anaesthesist able to titrate with exactness the level of sensorial block and offers a good postoperative analgesia. Because of the introduction of atraumatic needles PPDH has drammatically decreased: accidental PPDH takes place in a small but ingrained percentage. Recently spinal block has been described as a reliable choice even in preeclampsia and in pregnancy hypertension. Epidural opiates have a lower incidence of maddening side effects compared with spinal opiates and allow better maternal satisfaction as regard postoperative analgesia. In accordance with ASA guidelines there are no decisive reasons in order to choice spinal or epidural block: actually literature is unable to give a definitive suggestion about complications and advantages. The choice would be take place weighing up maternal wishes, fetal factors (elective versus urgent caesarean section) and the preferences of the anesthesiologist.