Two cases of cauda equina syndrome following spinal-epidural anesthesia.

BACKGROUND AND OBJECTIVES: Cauda equina syndrome (CES) is a well-known complication of spinal and epidural anesthesia. Previous reports have implicated lidocaine, chloroprocaine, and procaine in its etiology, but not bupivacaine. METHODS: A 63-year-old man underwent transurethral resection of the prostrate for which he received bupivacaine with glucose intrathecally. Postoperative, he had difficulty in urination and defecation, and magnetic resonance imaging revealed spinal stenosis at the L1-L2 level. The second patient was a 70-year-old woman who underwent hip replacement surgery using a combined spinal-epidural technique. Postoperative, after 42 hours, when the epidural infusion of bupivacaine was stopped, the patient had difficulty in urination and defecation. No anatomical abnormality was found on magnetic resonance imaging. RESULTS: The two patients developed cauda equina syndrome following bupivacaine with glucose injected spinally, and bupivacaine without glucose injected in a combined spinal-epidural technique. CONCLUSIONS: This case report describes two cases of CES following the use of bupivacaine. The first patient had spinal stenosis which could explain this complication; however the explanation for CES in the second patient is uncertain and consequently speculative. We have discussed the possible contributing factors but believe that the etiology of CES in the second patient remains unknown.

[Nociception and mental functions after combined neuroleptanalgesia]. / Nocicepcia a niektoré psychické funkcie po kombinovanej neuroleptanalgéze.

In a group of 25 patients divided at random into subgroups anaesthetized by neuroleptoanalgesia or ataralgesia resp. on account of arthroscopy, the authors assessed the state of mental functions--perception, memory before, and after operation, emotional make-up, affectivity, cognitive functions and some personality parameters. By means of an algometer and the cuff of a manometer they assessed the threshold of pressure and ischemic pressure pain. They found that in no instance intraoperative experience appeared, the threshold of nociceptive pressure perception was considerably reduced after operation in both groups. The threshold of ischemic pressure pain was significantly reduced only in the group with Hb greater than 150 and Le greater than 8.0, anaesthetized by neuroleptanalgesia. A significant increase of the depressivity (5%) was recorded in the group with combined neuroleptoanalgesia. Dysphoria and emotional indifference increased (5%) in the group with neuroleptanalgesia. Within 2-4 hours after termination of anaesthesia significant consolidation of long-term memory occurred, whereby short-term memory did not display any changes in either group i.e. regardless of the type of anaesthesia. Attention was significantly improved after both types of anaesthesia, but more markedly after neuroleptanalgesia. In the group with combined neuroleptanalgesia sensory and neurasthenic complaints improved (5%). The degree of experienced fear and anxiety in conjunction with the operation as well other psychic parameters before operation were equal in both groups and the groups were thus equivalent. In relation to the plasma cortisol level (degree of preoperative stress) there was a close correlation between the emotional lability on the one hand and maladaptation on the other. The degree of preoperative stress created a close correlation between fear and maladaptation on the one hand and frightening experience on the other.