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Darrell R. Schroeder - One of the best experts on this subject based on the ideXlab platform.
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Neuraxial Blockade in patients with preexisting spinal stenosis lumbar disk disease or prior spine surgery efficacy and neurologic complications
Anesthesia & Analgesia, 2010Co-Authors: James R. Hebl, Sandra L Kopp, Terese T. Horlocker, Darrell R. SchroederAbstract:BACKGROUND:Patients with spinal canal pathology, including spinal stenosis and lumbar disk disease, are often not considered candidates for Neuraxial Blockade because of the risk of exacerbating preexisting neurologic deficits or developing new neurologic dysfunction. In contrast, a history of spine
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Neuraxial Blockade in patients with preexisting spinal stenosis lumbar disk disease or prior spine surgery efficacy and neurologic complications
Anesthesia & Analgesia, 2010Co-Authors: James R. Hebl, Sandra L Kopp, Terese T. Horlocker, Darrell R. SchroederAbstract:BACKGROUND: Patients with spinal canal pathology, including spinal stenosis and lumbar disk disease, are often not considered candidates for Neuraxial Blockade because of the risk of exacerbating preexisting neurologic deficits or developing new neurologic dysfunction. In contrast, a history of spine surgery is thought to increase the likelihood of difficult or unsuccessful block. In this retrospective study we investigated the risk of neurologic complications and block efficacy in patients with preexisting spinal canal pathology, with or without a history of spine surgery, after Neuraxial anesthesia. METHODS: During the 15-year study period, all patients with a history of spinal stenosis or lumbar radiculopathy undergoing a Neuraxial technique were studied. Patient demographics, preoperative neurologic diagnoses and neurologic findings at the time of surgery/Neuraxial block, details of the Neuraxial block including technique (spinal vs. epidural, single injection vs. continuous), injectate, technical complications (paresthesia elicitation, bloody needle/catheter placement, inability to advance catheter, accidental dural puncture), and block success were noted. New or progressive neurologic deficits were identified. All patients were followed until resolution or last date of evaluation. RESULTS: There were 937 patients included, 207 (22%) of whom had undergone spinal surgery. A history of spinal stenosis was present in 187 (20%), lumbar radiculopathy in 570 (61%), and peripheral neuropathy in 210 (22%) patients; 180 patients (19%) had multiple neurologic diagnoses. A majority of patients had active but stable neurologic symptoms at the time of surgery. Overall block success was 97.2%. A history of spine surgery did not affect the success rate or frequency of technical complications. Ten (1.1%; 95% confidence interval [CI] 0.5%-2.0%) patients experienced new deficits or worsening of existing symptoms. Three (1.4%) complications occurred in patients with a history of spinal surgery, and the remaining 7 (1.0%) in patients without prior surgical decompression or stabilization (P = NS). Although an orthopedic procedure was not a risk factor, in 5 of the 6 patients in which the surgery was a unilateral lower extremity procedure, the postoperative deficit involved the operative side. Likewise, in both patients undergoing bilateral orthopedic procedures who developed bilateral deficits, the outcome was worse on the previously affected side. A surgical cause was presumed to be the primary etiology in 4 (40%) of 10 patients. The primary etiology of the remaining 6 (60%) complications was judged to be nonsurgical (including anesthetic-related factors). The presence of a preoperative diagnosis of compressive radiculopathy (P = 0.0495) or multiple neurologic diagnoses (P = 0.005) increased the risk of neurologic complications postoperatively. CONCLUSIONS: We conclude that patients with preexisting spinal canal pathology have a higher incidence of neurologic complications after Neuraxial Blockade (1.1%; 95% CI 0.5%-2.0%) than that previously reported for patients without such underlying pathology. However, in the absence of a control group of surgical patients with similar anatomic pathology undergoing general anesthesia, we cannot determine whether the higher incidence of neurologic injury is secondary to the surgical procedure, the anesthetic technique, the natural history of spinal pathology, or a combination of factors and the relative contributions of each.
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Neurologic complications after Neuraxial anesthesia or analgesia in patients with preexisting peripheral sensorimotor neuropathy or diabetic polyneuropathy.
Anesthesia & Analgesia, 2006Co-Authors: James R. Hebl, Sandra L Kopp, Darrell R. Schroeder, Terese T. HorlockerAbstract:BACKGROUND:The risk of severe neurologic injury after Neuraxial Blockade is extremely rare among the general population. However, patients with preexisting neural compromise may be at increased risk of further neurologic sequelae after Neuraxial anesthesia or analgesia.METHODS:We retrospectively inv
Ki Jinn Chin - One of the best experts on this subject based on the ideXlab platform.
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Recent developments in ultrasound imaging for Neuraxial Blockade.
Current opinion in anaesthesiology, 2018Co-Authors: Ki Jinn ChinAbstract:PURPOSE OF REVIEW Recent research has shed further light on the place of ultrasound imaging in Neuraxial Blockade in routine clinical practice, its use in thoracic epidurals, and real-time ultrasound-guided techniques. RECENT FINDINGS Compared with the conventional technique of surface landmark palpation, preprocedural ultrasound imaging minimizes technical difficulty associated with lumbar Neuraxial Blockade in patients with poor-quality surface landmarks. Novice practitioners are able to learn to employ the technique effectively. Safety benefits include a reduction in postprocedural back pain associated with fewer needle passes and a lower risk of procedure-associated bleeding. The advantage of ultrasound is minimal however in patients with easily discernible surface landmarks, especially if the practitioner is highly experienced. Recent trials show that preprocedural ultrasound scanning for thoracic epidural insertion reduces needle punctures and increases early analgesic efficacy compared with the palpation technique. Real-time ultrasound-guided techniques, while feasible, remain challenging and may not offer significant benefit over preprocedural imaging in lumbar Neuraxial Blockade. Their role in thoracic epidural insertion requires further investigation. SUMMARY Ultrasound imaging of the spine is a valuable technique that, while not indicated for routine use, should be part of the skillset of any practitioner that regularly performs lumbar and thoracic Neuraxial Blockade.
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Central Neuraxial Blockade: Ultrasound
Oxford Medicine Online, 2016Co-Authors: Ki Jinn ChinAbstract:Successful central Neuraxial Blockade requires entry into the epidural or intrathecal space, and is contingent on the ability to guide a needle into the desired interlaminar space between adjacent vertebrae. Ultrasonography of the spine has been shown to be an effective tool for guiding epidural and spinal anesthesia. The use of ultrasound to central Neuraxial Blockade can broadly be divided into either preprocedural ultrasound imaging to delineate the underlying anatomy, or real-time ultrasound imaging of the needle as it is advanced toward the target. This chapter focuses only on preprocedural ultrasound imaging of the thoracic and lumbar spine, as real-time ultrasound-guided central Neuraxial Blockade is a challenging technique that requires much more investigation before it can be recommended for routine use. There is ample evidence to support the utility of ultrasound imaging of the spine in facilitating central Neuraxial Blockade. It is particularly useful in patients with challenging surface landmarks.
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The ultrasound-assisted paraspinous approach to lumbar Neuraxial Blockade: a simplified technique in patients with difficult anatomy.
Acta anaesthesiologica Scandinavica, 2015Co-Authors: Ki Jinn Chin, Anahi Perlas, Vincent W. S. ChanAbstract:Pre-procedural ultrasound imaging of the spine to identify the interspinous and interlaminar space has been shown to facilitate subsequent performance of lumbar Neuraxial Blockade. However, adequate visualization of the vertebral canal can be challenging for less-experienced operators, and particularly in subjects with difficult anatomy. In this case report, we describe a simplified technique of ultrasound-assisted Neuraxial Blockade that addresses these limitations and may thus be a useful fallback option. A pre-procedural scan is performed in which the main ultrasonographic landmarks to be identified are the Neuraxial midline and the spinous processes, rather than the posterior and anterior complexes of the vertebral canal. Another key difference is the use of a paraspinous (or paramedian) needle approach rather than a midline approach that is advantageous where the interspinous spaces are narrowed by disease or suboptimal patient positioning. The anatomical basis and technical performance of this novel ultrasound-assisted paraspinous approach are presented in detail.
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Ultrasound for Central Neuraxial Blockade
Current Anesthesiology Reports, 2013Co-Authors: Kyle R. Kirkham, Ki Jinn ChinAbstract:The evidence base supporting the role of ultrasound to assist the performance of Neuraxial anesthesia has become increasingly strong over the last decade. In both the lumbar and thoracic spine, ultrasound has been shown to optimize technical performance, improve patient outcomes, and potentially reduce harm. Specifically, ultrasound aids in identification of intervertebral levels, estimation of depth to epidural and intrathecal spaces, and localization of important landmarks including the midline and interlaminar space. These characteristics can facilitate both planning and performance of Neuraxial Blockade by reducing the required number of needle insertions and redirections, minimizing the risk of traumatic needle placements, and improving block effectiveness after epidural placement. This report details the evidence supporting each of these outcomes and also discusses the current understanding of both learning and teaching the skill of Neuraxial ultrasonography.
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ultrasonography of the adult thoracic and lumbar spine for central Neuraxial Blockade
Anesthesiology, 2011Co-Authors: Ki Jinn Chin, Manoj K Karmakar, Philip PengAbstract:The role of ultrasound in central Neuraxial Blockade has been underappreciated, partly because of the relative efficacy of the landmark-guided technique and partly because of the perceived difficulty in imaging through the narrow acoustic windows produced by the bony framework of the spine. However, this also is the basis for the utility of ultrasound: an interlaminar window that permits passage of sound waves into the vertebral canal also will permit passage of a needle. In addition, ultrasound aids in identification of intervertebral levels, estimation of the depth to epidural and intrathecal spaces, and location of important landmarks, including the midline and interlaminar spaces. This can facilitate Neuraxial Blockade, particularly in patients with difficult surface anatomic landmarks. In this review article, the authors summarize the current literature, describe the key ultrasonographic views, and propose a systematic approach to ultrasound imaging for the performance of spinal and epidural anesthesia in the adult patient.
Sandra L Kopp - One of the best experts on this subject based on the ideXlab platform.
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Neuraxial Blockade for the prevention of postoperative mortality and major morbidity an overview of cochrane systematic reviews
Cochrane Database of Systematic Reviews, 2014Co-Authors: Joanne Guay, Sandra L Kopp, Peter T Choi, Santhanam Suresh, Natalie Albert, Nathan L PaceAbstract:Background Various beneficial effects derived from Neuraxial blocks have been reported. However, it is unclear whether these effects have an influence on perioperative mortality and major pulmonary/cardiovascular complications. Objectives Our primary objective was to summarize Cochrane systematic reviews that assess the effects of Neuraxial Blockade on perioperative rates of death, chest infection and myocardial infarction by integrating the evidence from all such reviews that have compared Neuraxial Blockade with or without general anaesthesia versus general anaesthesia alone for different types of surgery in various populations. Our secondary objective was to summarize the evidence on adverse effects (an adverse event for which a causal relation between the intervention and the event is at least a reasonable possibility) of Neuraxial Blockade. Within the reviews, studies were selected using the same criteria. Methods A search was performed in the Cochrane Database of Systematic Reviews on July 13, 2012. We have (1) included all Cochrane systematic reviews that examined participants of any age undergoing any type of surgical (open or endoscopic) procedure, (2) compared Neuraxial Blockade versus general anaesthesia alone for surgical anaesthesia or Neuraxial Blockade plus general anaesthesia versus general anaesthesia alone for surgical anaesthesia and (3) included death, chest infection, myocardial infarction and/or serious adverse events as outcomes. Neuraxial Blockade could consist of epidural, caudal, spinal or combined spinal-epidural techniques administered as a bolus or by continuous infusion. Studies included in these reviews were selected on the basis of the same criteria. Reviews and studies were selected independently by two review authors, who independently performed data extraction when data differed from one of the selected reviews. Data were analysed by using Review Manager Version 5.1 and Comprehensive Meta Analysis Version 2.2.044. Main results Nine Cochrane reviews were selected for this overview. Their scores on the Overview Quality Assessment Questionnaire varied from four to six of a maximal possible score of seven. Compared with general anaesthesia, Neuraxial Blockade reduced the zero to 30-day mortality (risk ratio [RR] 0.71, 95% confidence interval [CI] 0.53 to 0.94; I2 = 0%) based on 20 studies that included 3006 participants. Neuraxial Blockade also decreased the risk of pneumonia (RR 0.45, 95% CI 0.26 to 0.79; I2 = 0%) based on five studies that included 400 participants. No difference was detected in the risk of myocardial infarction between the two techniques (RR 1.17, 95% CI 0.57 to 2.37; I2 = 0%) based on six studies with 849 participants. Compared with general anaesthesia alone, the addition of a Neuraxial block to general anaesthesia did not affect the zero to 30-day mortality (RR 1.07, 95% CI 0.76 to 1.51; I2 = 0%) based on 18 studies with 3228 participants. No difference was detected in the risk of myocardial infarction between combined Neuraxial Blockade-general anaesthesia and general anaesthesia alone (RR 0.69, 95% CI 0.44 to 1.09; I2 = 0%) based on eight studies that included 1580 participants. The addition of a Neuraxial block to general anaesthesia reduced the risk of pneumonia (RR 0.69, 95% CI 0.49 to 0.98; I2 = 9%) after adjustment for publication bias and based on nine studies that included 2433 participants. The quality of the evidence was judged as moderate for all six comparisons. No serious adverse events (seizure or cardiac arrest related to local anaesthetic toxicity, prolonged central or peripheral neurological injury lasting longer than one month or infection secondary to Neuraxial Blockade) were reported. The quality of the reporting score of complications related to Neuraxial blocks was nine (four to 12 (median range)) of a possible maximum score of 14. Authors' conclusions Compared with general anaesthesia, a central Neuraxial block may reduce the zero to 30-day mortality for patients undergoing surgery with intermediate to high cardiac risk (level of evidence, moderate). Further research is required.
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The Cochrane Library - Neuraxial Blockade for the prevention of postoperative mortality and major morbidity: an overview of Cochrane systematic reviews.
The Cochrane database of systematic reviews, 2014Co-Authors: Joanne Guay, Sandra L Kopp, Peter T Choi, Santhanam Suresh, Natalie Albert, Nathan L PaceAbstract:Background Various beneficial effects derived from Neuraxial blocks have been reported. However, it is unclear whether these effects have an influence on perioperative mortality and major pulmonary/cardiovascular complications. Objectives Our primary objective was to summarize Cochrane systematic reviews that assess the effects of Neuraxial Blockade on perioperative rates of death, chest infection and myocardial infarction by integrating the evidence from all such reviews that have compared Neuraxial Blockade with or without general anaesthesia versus general anaesthesia alone for different types of surgery in various populations. Our secondary objective was to summarize the evidence on adverse effects (an adverse event for which a causal relation between the intervention and the event is at least a reasonable possibility) of Neuraxial Blockade. Within the reviews, studies were selected using the same criteria. Methods A search was performed in the Cochrane Database of Systematic Reviews on July 13, 2012. We have (1) included all Cochrane systematic reviews that examined participants of any age undergoing any type of surgical (open or endoscopic) procedure, (2) compared Neuraxial Blockade versus general anaesthesia alone for surgical anaesthesia or Neuraxial Blockade plus general anaesthesia versus general anaesthesia alone for surgical anaesthesia and (3) included death, chest infection, myocardial infarction and/or serious adverse events as outcomes. Neuraxial Blockade could consist of epidural, caudal, spinal or combined spinal-epidural techniques administered as a bolus or by continuous infusion. Studies included in these reviews were selected on the basis of the same criteria. Reviews and studies were selected independently by two review authors, who independently performed data extraction when data differed from one of the selected reviews. Data were analysed by using Review Manager Version 5.1 and Comprehensive Meta Analysis Version 2.2.044. Main results Nine Cochrane reviews were selected for this overview. Their scores on the Overview Quality Assessment Questionnaire varied from four to six of a maximal possible score of seven. Compared with general anaesthesia, Neuraxial Blockade reduced the zero to 30-day mortality (risk ratio [RR] 0.71, 95% confidence interval [CI] 0.53 to 0.94; I2 = 0%) based on 20 studies that included 3006 participants. Neuraxial Blockade also decreased the risk of pneumonia (RR 0.45, 95% CI 0.26 to 0.79; I2 = 0%) based on five studies that included 400 participants. No difference was detected in the risk of myocardial infarction between the two techniques (RR 1.17, 95% CI 0.57 to 2.37; I2 = 0%) based on six studies with 849 participants. Compared with general anaesthesia alone, the addition of a Neuraxial block to general anaesthesia did not affect the zero to 30-day mortality (RR 1.07, 95% CI 0.76 to 1.51; I2 = 0%) based on 18 studies with 3228 participants. No difference was detected in the risk of myocardial infarction between combined Neuraxial Blockade-general anaesthesia and general anaesthesia alone (RR 0.69, 95% CI 0.44 to 1.09; I2 = 0%) based on eight studies that included 1580 participants. The addition of a Neuraxial block to general anaesthesia reduced the risk of pneumonia (RR 0.69, 95% CI 0.49 to 0.98; I2 = 9%) after adjustment for publication bias and based on nine studies that included 2433 participants. The quality of the evidence was judged as moderate for all six comparisons. No serious adverse events (seizure or cardiac arrest related to local anaesthetic toxicity, prolonged central or peripheral neurological injury lasting longer than one month or infection secondary to Neuraxial Blockade) were reported. The quality of the reporting score of complications related to Neuraxial blocks was nine (four to 12 (median range)) of a possible maximum score of 14. Authors' conclusions Compared with general anaesthesia, a central Neuraxial block may reduce the zero to 30-day mortality for patients undergoing surgery with intermediate to high cardiac risk (level of evidence, moderate). Further research is required.
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Neuraxial Blockade in patients with preexisting spinal stenosis lumbar disk disease or prior spine surgery efficacy and neurologic complications
Anesthesia & Analgesia, 2010Co-Authors: James R. Hebl, Sandra L Kopp, Terese T. Horlocker, Darrell R. SchroederAbstract:BACKGROUND:Patients with spinal canal pathology, including spinal stenosis and lumbar disk disease, are often not considered candidates for Neuraxial Blockade because of the risk of exacerbating preexisting neurologic deficits or developing new neurologic dysfunction. In contrast, a history of spine
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Neuraxial Blockade in patients with preexisting spinal stenosis lumbar disk disease or prior spine surgery efficacy and neurologic complications
Anesthesia & Analgesia, 2010Co-Authors: James R. Hebl, Sandra L Kopp, Terese T. Horlocker, Darrell R. SchroederAbstract:BACKGROUND: Patients with spinal canal pathology, including spinal stenosis and lumbar disk disease, are often not considered candidates for Neuraxial Blockade because of the risk of exacerbating preexisting neurologic deficits or developing new neurologic dysfunction. In contrast, a history of spine surgery is thought to increase the likelihood of difficult or unsuccessful block. In this retrospective study we investigated the risk of neurologic complications and block efficacy in patients with preexisting spinal canal pathology, with or without a history of spine surgery, after Neuraxial anesthesia. METHODS: During the 15-year study period, all patients with a history of spinal stenosis or lumbar radiculopathy undergoing a Neuraxial technique were studied. Patient demographics, preoperative neurologic diagnoses and neurologic findings at the time of surgery/Neuraxial block, details of the Neuraxial block including technique (spinal vs. epidural, single injection vs. continuous), injectate, technical complications (paresthesia elicitation, bloody needle/catheter placement, inability to advance catheter, accidental dural puncture), and block success were noted. New or progressive neurologic deficits were identified. All patients were followed until resolution or last date of evaluation. RESULTS: There were 937 patients included, 207 (22%) of whom had undergone spinal surgery. A history of spinal stenosis was present in 187 (20%), lumbar radiculopathy in 570 (61%), and peripheral neuropathy in 210 (22%) patients; 180 patients (19%) had multiple neurologic diagnoses. A majority of patients had active but stable neurologic symptoms at the time of surgery. Overall block success was 97.2%. A history of spine surgery did not affect the success rate or frequency of technical complications. Ten (1.1%; 95% confidence interval [CI] 0.5%-2.0%) patients experienced new deficits or worsening of existing symptoms. Three (1.4%) complications occurred in patients with a history of spinal surgery, and the remaining 7 (1.0%) in patients without prior surgical decompression or stabilization (P = NS). Although an orthopedic procedure was not a risk factor, in 5 of the 6 patients in which the surgery was a unilateral lower extremity procedure, the postoperative deficit involved the operative side. Likewise, in both patients undergoing bilateral orthopedic procedures who developed bilateral deficits, the outcome was worse on the previously affected side. A surgical cause was presumed to be the primary etiology in 4 (40%) of 10 patients. The primary etiology of the remaining 6 (60%) complications was judged to be nonsurgical (including anesthetic-related factors). The presence of a preoperative diagnosis of compressive radiculopathy (P = 0.0495) or multiple neurologic diagnoses (P = 0.005) increased the risk of neurologic complications postoperatively. CONCLUSIONS: We conclude that patients with preexisting spinal canal pathology have a higher incidence of neurologic complications after Neuraxial Blockade (1.1%; 95% CI 0.5%-2.0%) than that previously reported for patients without such underlying pathology. However, in the absence of a control group of surgical patients with similar anatomic pathology undergoing general anesthesia, we cannot determine whether the higher incidence of neurologic injury is secondary to the surgical procedure, the anesthetic technique, the natural history of spinal pathology, or a combination of factors and the relative contributions of each.
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Anticoagulation in Pregnancy and Neuraxial Blocks
Anesthesiology clinics, 2008Co-Authors: Sandra L Kopp, Terese T. HorlockerAbstract:The peripartum management of the anticoagulated parturient represents a significant clinical challenge to both the obstetrician and the anesthesiologist. This review discusses the causes of thrombosis in the pregnant population, the anticoagulants used for prophylaxis, and treatment of these disorders, along with recommendations for Neuraxial Blockade in parturients who receive peripartum anticoagulation.
James R. Hebl - One of the best experts on this subject based on the ideXlab platform.
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Neuraxial Blockade in patients with preexisting spinal stenosis lumbar disk disease or prior spine surgery efficacy and neurologic complications
Anesthesia & Analgesia, 2010Co-Authors: James R. Hebl, Sandra L Kopp, Terese T. Horlocker, Darrell R. SchroederAbstract:BACKGROUND:Patients with spinal canal pathology, including spinal stenosis and lumbar disk disease, are often not considered candidates for Neuraxial Blockade because of the risk of exacerbating preexisting neurologic deficits or developing new neurologic dysfunction. In contrast, a history of spine
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Neuraxial Blockade in patients with preexisting spinal stenosis lumbar disk disease or prior spine surgery efficacy and neurologic complications
Anesthesia & Analgesia, 2010Co-Authors: James R. Hebl, Sandra L Kopp, Terese T. Horlocker, Darrell R. SchroederAbstract:BACKGROUND: Patients with spinal canal pathology, including spinal stenosis and lumbar disk disease, are often not considered candidates for Neuraxial Blockade because of the risk of exacerbating preexisting neurologic deficits or developing new neurologic dysfunction. In contrast, a history of spine surgery is thought to increase the likelihood of difficult or unsuccessful block. In this retrospective study we investigated the risk of neurologic complications and block efficacy in patients with preexisting spinal canal pathology, with or without a history of spine surgery, after Neuraxial anesthesia. METHODS: During the 15-year study period, all patients with a history of spinal stenosis or lumbar radiculopathy undergoing a Neuraxial technique were studied. Patient demographics, preoperative neurologic diagnoses and neurologic findings at the time of surgery/Neuraxial block, details of the Neuraxial block including technique (spinal vs. epidural, single injection vs. continuous), injectate, technical complications (paresthesia elicitation, bloody needle/catheter placement, inability to advance catheter, accidental dural puncture), and block success were noted. New or progressive neurologic deficits were identified. All patients were followed until resolution or last date of evaluation. RESULTS: There were 937 patients included, 207 (22%) of whom had undergone spinal surgery. A history of spinal stenosis was present in 187 (20%), lumbar radiculopathy in 570 (61%), and peripheral neuropathy in 210 (22%) patients; 180 patients (19%) had multiple neurologic diagnoses. A majority of patients had active but stable neurologic symptoms at the time of surgery. Overall block success was 97.2%. A history of spine surgery did not affect the success rate or frequency of technical complications. Ten (1.1%; 95% confidence interval [CI] 0.5%-2.0%) patients experienced new deficits or worsening of existing symptoms. Three (1.4%) complications occurred in patients with a history of spinal surgery, and the remaining 7 (1.0%) in patients without prior surgical decompression or stabilization (P = NS). Although an orthopedic procedure was not a risk factor, in 5 of the 6 patients in which the surgery was a unilateral lower extremity procedure, the postoperative deficit involved the operative side. Likewise, in both patients undergoing bilateral orthopedic procedures who developed bilateral deficits, the outcome was worse on the previously affected side. A surgical cause was presumed to be the primary etiology in 4 (40%) of 10 patients. The primary etiology of the remaining 6 (60%) complications was judged to be nonsurgical (including anesthetic-related factors). The presence of a preoperative diagnosis of compressive radiculopathy (P = 0.0495) or multiple neurologic diagnoses (P = 0.005) increased the risk of neurologic complications postoperatively. CONCLUSIONS: We conclude that patients with preexisting spinal canal pathology have a higher incidence of neurologic complications after Neuraxial Blockade (1.1%; 95% CI 0.5%-2.0%) than that previously reported for patients without such underlying pathology. However, in the absence of a control group of surgical patients with similar anatomic pathology undergoing general anesthesia, we cannot determine whether the higher incidence of neurologic injury is secondary to the surgical procedure, the anesthetic technique, the natural history of spinal pathology, or a combination of factors and the relative contributions of each.
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Neurologic complications after Neuraxial anesthesia or analgesia in patients with preexisting peripheral sensorimotor neuropathy or diabetic polyneuropathy.
Anesthesia & Analgesia, 2006Co-Authors: James R. Hebl, Sandra L Kopp, Darrell R. Schroeder, Terese T. HorlockerAbstract:BACKGROUND:The risk of severe neurologic injury after Neuraxial Blockade is extremely rare among the general population. However, patients with preexisting neural compromise may be at increased risk of further neurologic sequelae after Neuraxial anesthesia or analgesia.METHODS:We retrospectively inv
Terese T. Horlocker - One of the best experts on this subject based on the ideXlab platform.
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Neuraxial Blockade in patients with preexisting spinal stenosis lumbar disk disease or prior spine surgery efficacy and neurologic complications
Anesthesia & Analgesia, 2010Co-Authors: James R. Hebl, Sandra L Kopp, Terese T. Horlocker, Darrell R. SchroederAbstract:BACKGROUND:Patients with spinal canal pathology, including spinal stenosis and lumbar disk disease, are often not considered candidates for Neuraxial Blockade because of the risk of exacerbating preexisting neurologic deficits or developing new neurologic dysfunction. In contrast, a history of spine
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Neuraxial Blockade in patients with preexisting spinal stenosis lumbar disk disease or prior spine surgery efficacy and neurologic complications
Anesthesia & Analgesia, 2010Co-Authors: James R. Hebl, Sandra L Kopp, Terese T. Horlocker, Darrell R. SchroederAbstract:BACKGROUND: Patients with spinal canal pathology, including spinal stenosis and lumbar disk disease, are often not considered candidates for Neuraxial Blockade because of the risk of exacerbating preexisting neurologic deficits or developing new neurologic dysfunction. In contrast, a history of spine surgery is thought to increase the likelihood of difficult or unsuccessful block. In this retrospective study we investigated the risk of neurologic complications and block efficacy in patients with preexisting spinal canal pathology, with or without a history of spine surgery, after Neuraxial anesthesia. METHODS: During the 15-year study period, all patients with a history of spinal stenosis or lumbar radiculopathy undergoing a Neuraxial technique were studied. Patient demographics, preoperative neurologic diagnoses and neurologic findings at the time of surgery/Neuraxial block, details of the Neuraxial block including technique (spinal vs. epidural, single injection vs. continuous), injectate, technical complications (paresthesia elicitation, bloody needle/catheter placement, inability to advance catheter, accidental dural puncture), and block success were noted. New or progressive neurologic deficits were identified. All patients were followed until resolution or last date of evaluation. RESULTS: There were 937 patients included, 207 (22%) of whom had undergone spinal surgery. A history of spinal stenosis was present in 187 (20%), lumbar radiculopathy in 570 (61%), and peripheral neuropathy in 210 (22%) patients; 180 patients (19%) had multiple neurologic diagnoses. A majority of patients had active but stable neurologic symptoms at the time of surgery. Overall block success was 97.2%. A history of spine surgery did not affect the success rate or frequency of technical complications. Ten (1.1%; 95% confidence interval [CI] 0.5%-2.0%) patients experienced new deficits or worsening of existing symptoms. Three (1.4%) complications occurred in patients with a history of spinal surgery, and the remaining 7 (1.0%) in patients without prior surgical decompression or stabilization (P = NS). Although an orthopedic procedure was not a risk factor, in 5 of the 6 patients in which the surgery was a unilateral lower extremity procedure, the postoperative deficit involved the operative side. Likewise, in both patients undergoing bilateral orthopedic procedures who developed bilateral deficits, the outcome was worse on the previously affected side. A surgical cause was presumed to be the primary etiology in 4 (40%) of 10 patients. The primary etiology of the remaining 6 (60%) complications was judged to be nonsurgical (including anesthetic-related factors). The presence of a preoperative diagnosis of compressive radiculopathy (P = 0.0495) or multiple neurologic diagnoses (P = 0.005) increased the risk of neurologic complications postoperatively. CONCLUSIONS: We conclude that patients with preexisting spinal canal pathology have a higher incidence of neurologic complications after Neuraxial Blockade (1.1%; 95% CI 0.5%-2.0%) than that previously reported for patients without such underlying pathology. However, in the absence of a control group of surgical patients with similar anatomic pathology undergoing general anesthesia, we cannot determine whether the higher incidence of neurologic injury is secondary to the surgical procedure, the anesthetic technique, the natural history of spinal pathology, or a combination of factors and the relative contributions of each.
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Anticoagulation in Pregnancy and Neuraxial Blocks
Anesthesiology clinics, 2008Co-Authors: Sandra L Kopp, Terese T. HorlockerAbstract:The peripartum management of the anticoagulated parturient represents a significant clinical challenge to both the obstetrician and the anesthesiologist. This review discusses the causes of thrombosis in the pregnant population, the anticoagulants used for prophylaxis, and treatment of these disorders, along with recommendations for Neuraxial Blockade in parturients who receive peripartum anticoagulation.
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Neurologic complications after Neuraxial anesthesia or analgesia in patients with preexisting peripheral sensorimotor neuropathy or diabetic polyneuropathy.
Anesthesia & Analgesia, 2006Co-Authors: James R. Hebl, Sandra L Kopp, Darrell R. Schroeder, Terese T. HorlockerAbstract:BACKGROUND:The risk of severe neurologic injury after Neuraxial Blockade is extremely rare among the general population. However, patients with preexisting neural compromise may be at increased risk of further neurologic sequelae after Neuraxial anesthesia or analgesia.METHODS:We retrospectively inv