Zübeyde ATEŞ ÇETİN, NURTEN KAYACAN, BİLGE KARSLI

Santral blok sonrası geçici nörolojik semptomlar

Amaç: Santral blok sonrası gözlenen GNS, hastaların zorlukla farkına varabildikleri dizesteziden, çok şiddetli ağrıya kadar oldukça değişken ve geniş şikayetler dizisini içermektedir. GNS sıklığını ve potansiyelize eden risk faktörlerinin belirlenmesini amaçlayan bu çalışmaya, santral blok uygulanan 591 hasta dahil edildi. Gereç ve Yöntem: Operasyon öncesi hastaların demografik bilgileri, operasyon ve uygulanan blok türüne ait özellikler kaydedildi. Hastalar postoperatif 24, 48 saat ve 7. günde GNS olarak ağrı (başağrısı, bel ve/veya bacak ağrısı, sırt ağrısı, girişim yeri ağrısı) ve duyu kusurları (parestezi, hipoestezi, hiperestezi, anestezi, dizestezi) açısından değerlendirildi. Bulgular: Çalışmaya katılan hastalarda GNS sıklığı, %35.7 olarak hesaplanırken, bu oran KHD, üroloji hastalarında anlamlı olarak yüksekti. GNS, kadın hastalarda erkek hastalara göre anlamlı olarak fazla bulundu. Santral blok uygulamaları sırasında iğne/ kateterden kan gelmesi, ağrı ve parestezi varlığında, GNS insidansında artma izlenirken, kullanılan LA ajanlar arasında, GNS insidansında farklılık bulunmadı. Sonuç: Çalışmamızda literatür bilgileriyle benzer GNS oranları bulduk. Artan ponksiyon sayısı, litotomi pozisyonu, eşlik eden ASKH ve DM gibi komorbid durumlar GNS insidansını artırmaktadır.

Transient neurological symptoms after spinal anesthesia

Objectives: Transient neurological symptoms (TNS) after spinal anesthesia vary from dysesthesia that is hardly noticed to severe pain. The aim of this study was to determine the incidence of TNS and provocative risk factors in 591 patients who underwent central block. Methods: Before the operation, demographic data and features of the operation and the block were recorded. The patients were evaluated at postoperative 24 and 48 hours and day 7 with regard to TNS in the form of pain (headache, lower back and/or limb pain, backache, pain in the puncture region) and sensation disorders (paresthesia, hypoesthesia, hyperesthesia, anesthesia, dysesthesia). Results: The incidence of TNS among the study patients was 35.7%. It was significantly higher in gynecology and urology patients and was higher in female patients in comparison with male patients. The incidence of TNS was greater when blood in the needle/catheter, pain, or paresthesia was seen, but was not associated with LA agents used in the study. Conclusion: A similar TNS incidence was seen in the results of this study as has been reported in the literature. A greater number of attempts, the lithotomy position, and co-morbidities such as ASHD and DM increase the incidence of TNS.

PDF

___

Zaric D, Pace NL. Transient neurologic symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics. Cochrane Database Syst Rev 2009:CD003006.
Pollock JE, Burkhead D, Neal JM, Liu SS, Friedman A, Stephenson C, et al. Spinal nerve function in five volunteers experiencing transient neurologic symptoms after lidocaine subarachnoid anesthesia. Anesth Analg 2000;90(3):658–65.
Salmela L, Aromaa U, Cozanitis DA. Leg and back pain after spinal anaesthesia involving hyperbaric 5% lignocaine. Anaesthesia 1996;51(4):391–3.
İnanoğlu K, Çağla Özbakış Akkurt B, Yetim Ç. A transient prolonged paresthesia folloeing spinal anesthesia with hiberbaric bupivacaine during caeserean section, Türk Anest Rean Der Dergisi 2006; 34(6):401–404.
Selander D, Dhunér KG, Lundborg G. Peripheral nerve injury due to injection needles used for regional anesthesia An experimental study of the acute effects of needle point trauma. Acta Anaesthesiol Scand 1977;21(3):182–8.
Aldrete JA. Neurologic deficits and arachnoiditis following neuroaxial anesthesia. Acta Anaesthesiol Scand 2003;47(1):3–12.
Russell R, Groves P, Taub N, O’Dowd J, Reynolds F. Assessing long term backache after childbirth. BMJ 1993;306(6888):1299–303.
MacArthur C, Lewis M, Knox EG, Crawford JS. Epidural anaesthesia and long term backache after childbirth. BMJ 1990;301(6742):9–12.
Flaatten H, Raeder J. Spinal anaesthesia for outpatient surgery. Anaesthesia 1985;40(11):1108–11.Brattebø G, Wisborg T, Rodt SA, Røste I. Is the pencil point spinal needle a better choice in younger patients? A comparison of 24G Sprotte with 27G Quincke needles in an unselected group of general surgical patients below 46 years of age. Acta Anaesthesiol Scand 1995;39(4):535–8.
Phillips OC, Ebner H, Nelson AT, Black MH. Neurologic complications following spinal anesthesia with lidocaine: a prospective review of 10,440 cases. Anesthesiology 1969;30(3):284–9.
Edomwonyi NP, Isesele TO. Transient neurological symptoms following spinal anesthesia for cesarean section. Middle East J Anaesthesiol 2010;20(6):809–13.
Geurts JW, Haanschoten MC, van Wijk RM, Kraak H, Besse TC. Post-dural puncture headache in young patients. A comparative study between the use of 0.52 mm (25-gauge) and 0.33 mm (29-gauge) spinal needles. Acta Anaesthesiol Scand 1990;34(5):350–3.
Frenkel C, Altscher T, Groben V, Hörnchen U. The incidence of post spinal headache in a group of young patients. Anaesthesist 1992;41(3):142–5.
Lim M, Cross GD, Sold M. Postspinal headache. A comparison of the 24G Sprotte syringe and a 29G Quincke needle. Anaesthesist 1992;41(9):539–43.
Seeberger MD, Lang ML, Drewe J, Schneider M, Hauser E, Hruby J. Comparison of spinal and epidural anesthesia for patients younger than 50 years of age. Anesth Analg 1994;78(4):667–73.
Shutt LE, Valentine SJ, Wee MY, Page RJ, Prosser A, Thomas TA. Spinal anaesthesia for caesarean section: comparison of 22-gauge and 25-gauge Whitacre needles with 26-gauge Quincke needles. Br J Anaesth 1992;69(6):589–94.
Pittoni G, Toffoletto F, Calcarella G, Zanette G, Giron GP. Spinal anesthesia in outpatient knee surgery: 22-gauge versus 25-gaugeSprotte needle. Anesth Analg 1995;81(1):73–9.
Lynch J, Arhelger S, Krings-Ernst I. Post-dural puncture headache in young orthopaedic in-patients: comparison of a 0.33 mm (29-gauge) Quincke-type with a 0.7 mm (22-gauge) Whitacre spinal needle in 200 patients. Acta Anaesthesiol Scand 1992;36(1):58–61.
Cesarini M, Torrielli R, Lahaye F, Mene JM, Cabiro C. Sprotte needle for intrathecal anaesthesia for caesarean section: incidence of postdural puncture headache. Anaesthesia 1990;45(8):656–8.
Flaatten H, Felthaus J, Kuwelker M, Wisborg T. Postural post-dural puncture headache. A prospective randomised study and a meta-analysis comparing two different 0.40 mm O.D. (27 g) spinal needles. Acta Anaesthesiol Scand 2000;44(6):643–7.
Schultz AM, Ulbing S, Kaider A, Lehofer F. Postdural puncture headache and back pain after spinal anesthesia with 27-gauge Quincke and 26-gauge Atraucan needles. Reg Anesth 1996;21(5):461–4.
Tarkkila PJ, Heine H, Tervo RR. Comparison of Sprotte and Quincke needles with respect to post dural puncture headache and backache. Reg Anesth 1992;17(5):283–7.
Cantais E, Behnamou D, Petit D, Palmier B. Acute subdural hematoma following spinal anesthesia with a very small spinalneedle. Anesthesiology 2000;93(5):1354–6.
Lambert DH, Hurley RJ, Hertwig L, Datta S. Role of needle gauge and tip configuration in the production of lumbarpuncture headache. Reg Anesth 1997;22(1):66–72.
Ghaleb A. Postdural puncture headache. Anesthesiol Res Pract 2010;2010. pii: 102967.
Bridenbaugh PO, Grene NM, Brull JS, Cousins MJ, Veering BT, Willis RJ. Central. Neural Blockade.In: Bridenbaugh PO, Lippincot-Raven, editors. Clinical anesthesia and manegement of pain. 3rd ed. NewYork: Lippincot-Raven, 1998. p.203-342.
Despond O, Meuret P, Hemmings G. Postdural puncture headache after spinal anaesthesia in young orthopaedic outpatients using 27-g needles. Can J Anaesth 1998;45(11):1106–9.
Jeanjean P, Montpellier D, Carnec J, Crasquin O, Koral E, Line B, et al. Headaches after spinal anesthesia: prospective multicenter study of a young adult population. Ann Fr Anesth Reanim 1997;16(4):350–3.
Hafer J, Rupp D, Wollbrück M, Engel J, Hempelmann G. The effect of needle type and immobilization on postspinal headache. Anaesthesist 1997;46:860–6.
Alemohammad S, Bouzarth WF. Intracranial subdural hematoma following lumbar myelography. Case report. J Neurosurg 1980;52(2):256–8.
Wong CA, Slavenas P. The incidence of transient radicular irritation after spinal anesthesia in obstetric patients. Reg Anesth Pain Med 1999;24(1):55–8.
Liguori GA, Zayas VM, Chisholm MF. Transient neurologic symptoms after spinal anesthesia with mepivacaine and lidocaine. Anesthesiology 1998;88(3):619–23.
Keld DB, Hein L, Dalgaard M, Krogh L, Rodt SA. The incidence of transient neurologic symptoms (TNS) after spinal anaesthesia in patients undergoing surgery in the supine position. Hyperbaric lidocaine 5% versus hyperbaric bupivacaine 0.5%. Acta Anaesthesiol Scand 2000;44(3):285–90.
Carpenter RL, Hogan QH, Liu SS, Crane B, Moore J. Lumbosacral cerebrospinal fluid volume is the primary determinant of sensory block extent and duration during spinal anesthesia. Anesthesiology 1998;89(1):24–9.
de Weert K, Traksel M, Gielen M, Slappendel R, Weber E, Dirksen R. The incidence of transient neurological symptoms after spinal anaesthesia with lidocaine compared to prilocaine. Anaesthesia 2000;55(10):1020–4.
Pollock JE, Neal JM, Stephenson CA, Wiley CE. Prospective study of the incidence of trancient radicular irritation in patients undergoing spinal anesthesia. Anesthesiology 1996;84(6):1361–67.
Hampl KF, Schneider MC, Pargger H, Gut J, Drewe J, Drasner K. A similar incidence of transient neurologic symptoms after spinal anesthesia with 2% and 5% lidocaine. Anesth Analg 1996;83(5):1051–4.
Hampl KF, Schneider MC, Thorin D, Ummenhofer W, Drewe J. Hyperosmolarity does not contribute to transient radicular irritation after spinal anesthesia with hyperbaric 5% lidocaine. Reg Anesth 1995; 20(5):363–8.
Evron S, Gurstieva V, Ezri T, Gladkov V, Shopin S, Herman A, et al. Transient neurological symptoms after isobaric subarachnoid anesthesia with 2% lidocaine: the impact of needle type. Anesth Analg 2007;105(5):1494–9.
Lindh A, Andersson AS, Westman L. Is transient lumbar pain after spinal anaesthesia with lidocaine influenced by early mobilisation? Acta Anaesthesiol Scand 2001;45(3):290–3.
Freedman JM, Li DK, Drasner K, Jaskela MC, Larsen B, Wi S. Transient neurologic symptoms after spinal anesthesia: an epidemiologic study of 1,863 patients. Anesthesiology 1998;89(3):633–41.
Hampl KF, Schneider MC, Ummenhofer W, Drewe J. Transient neurologic symptoms after spinal anesthesia. Anesth Analg 1995;81(6):1148–53.
Pollock JE, Liu SS, Neal JM, Stephenson CA. Dilution of spinal lidocaine does not alter the incidence of transient neurologic symptoms. Anesthesiology 1999;90(2):445–50.
Hampl KF, Heinzmann-Wiedmer S, Luginbuehl I, Harms C, Seeberger M, Schneider MC, et al. Transient neurologic symptoms after spinal anesthesia: a lower incidence with prilocaine and bupivacaine than with lidocaine. Anesthesiology 1998;88(3):629–33.
Sjöström S, Bläss J. Severe pain in both legs after spinal anaesthesia with hyperbaric 5% lignocaine solution. Anaesthesia 1994;49(8):700–2.
Schneider M, Ettlin T, Kaufmann M, Schumacher P, Urwyler A, Hampl K, et al. Transient neurologic toxicity after hyperbaric subarachnoid anesthesia with 5% lidocaine. Anesth Analg 1993;76(5):1154–7.
Salazar F, Bogdanovich A, Adalia R, Chabás E, Gomar C. Transient neurologic symptoms after spinal anaesthesia using isobaric 2% mepivacaine and isobaric 2% lidocaine. Acta Anaesthesiol Scand 2001;45(2):240–5.
Crosby E, Sandler A, Finucane B, Writer D, Reid D, McKenna J, et al. Comparison of epidural anaesthesia with ropivacaine 0.5% and bupivacaine 0.5% for caesarean section. Can J Anaesth 1998;45(11):1066–71.
Collin VJ. Regional Anesthesia, In: Principles of Anesthesiology. 3rd ed. Philadelphia: Lea & Febiger; 1993. p. 1199–641.
Morgan GE, Mikhail MS, Murray MJ, Larson CP. Regional Anesthesia&Pain Management In: Morgan GE, editor. Clinical Anesthesiology. 3rd ed. Los Angeles: The McGraw-Hill Companies; 2002. p.253–344.
Pollock JE. Transient neurologic symptoms: etiology, risk factors, and management. Reg Anesth Pain Med 2002;27(6):581–6.
Pollock JE. Management of the patient who develops transient neurologic symptoms after spinal anesthesia with lidocaine. Techniques in Regional Anesthesia and Pain Management 2000;4:155–60.
Kleinman W. Spinal, epidural and caudal blocks. In: Morgan. GE, Mikhail MS, Murray MJ, Larson CP, editors. Clinical anesthesiology. 3rd ed. New York: Lange Medical Books, Mc Graw-Hill; 2002. p. 253-82.
Brown DL. Spinal, epidural, and caudal anesthesia. In: Miller RD, editor. Miller’s Anesthesia. 6th edition. Philadelphia: Churchill Livingstone; 2005. p. 1653–83.
Morgan GE, Mikhail MS, Murray MJ, Larson CP. Local anesthetics, Clinical.Anesthesiology. 3rd edition. Los Angeles: The McGraw-Hill Companies; 2002. p. 253–344.