Neurologic complications after neuraxial anesthesia or analgesia in patients with preexisting peripheral sensorimotor neuropathy or diabetic polyneuropathy
Neurologic complications after neuraxial anesthesia or analgesia in patients with preexisting peripheral sensorimotor neuropathy or diabetic polyneuropathy
复制标题
DOI：
10.1213/01.ane.0000243384.75713.df
复制
发表时间：
2006-11-01
影响因子：
5.7
通讯作者：
Horlocker, Terese T.
中科院分区：
文献类型：
--
作者：
Hebl, James R.;Kopp, Sandra L.;Horlocker, Terese T.
背景：在一般人群中，轴索阻滞后发生严重神经损伤的风险极为罕见。然而，预先存在的神经损害的患者可能会在增加的风险后，neuraxial麻醉或alpensem.METHODS：我们回顾性研究了567例预先存在的周围感觉运动神经病变或糖尿病性多发性神经病变，随后进行neuraxial麻醉或镇痛。收集每例患者的人口统计学资料、神经系统病史、轴索阻滞的适应症和类型、并发症和阻滞结果。大多数患者在神经阻滞放置时有长期稳定的神经系统体征或症状，在最后6个月内很少报告症状进展。325例（57%）患者的神经轴技术类型包括脊髓麻醉，214例（38%）患者采用硬膜外麻醉或镇痛，24例（4%）患者采用连续脊髓麻醉，4例（1%）患者采用脊髓-硬膜外联合技术。总体而言，2例（0.4%; 95% CI 0.1%-1.3%）患者在无事件的神经轴技术背景下发生了新发或进行性术后神经系统疾病。在这些患者中，轴索阻滞的缺陷可能导致继发于直接创伤或局部麻醉神经毒性的损伤。63名患者发生了65例（11.5%）技术并发症。最常见的并发症是意外诱发感觉异常（7.6%），其次是创伤性（血液证据）穿刺针放置（1.6%）和计划外硬膜穿刺（0.9%）。没有感染或血液学并发症。结论：周围感觉运动神经病或糖尿病性多发性神经病患者接受轴索麻醉或镇痛的严重术后神经功能障碍的风险为0.4%（95%CI 0.1%-1.3%）。临床医生在制定和实施区域麻醉护理计划时，应了解这一潜在的高风险患者亚组。
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 investigated 567 patients with a preexisting peripheral sensorimotor neuropathy or diabetic polyneuropathy who subsequently underwent neuraxial anesthesia or analgesia. Patient demographics, neurologic history, the indication and type of neuraxial blockade, complications, and block outcome were collected for each patient.RESULTS: The majority of patients had chronically stable neurologic signs or symptoms at the time of block placement, with very few reporting progression of their symptoms within the last 6 me. The type of neuraxial technique included spinal anesthesia in 325 (57%) patients, epidural anesthesia or analgesia in 214 (38%) patients, continuous spinal anesthesia in 24 (4%) patients, and a combined spinal-epidural technique in four (1%) patients. Overall, two (0.4%; 95% CI 0.1%-1.3%) patients experienced new or progressive postoperative neurologic the setting of an uneventful neuraxial technique. In these patients, the deficits, in neuraxial block may have contributed to the injury secondary to direct trauma or local anesthetic neurotoxicity around an already vulnerable nerve. Sixty-five (11.5%) technical complications occurred in 63 patients. The most common complication was unintentional elicitation of a paresthesia (7.6%), followed by traumatic (evidence of blood) needle placement (1.6%) and unplanned dural puncture (0.9%). There were no infectious or hematologic complications.CONCLUSIONS: The risk of severe postoperative neurologic dysfunction in patients with peripheral sensorimotor neuropathy or diabetic polyneuropathy undergoing neuraxial anesthesia or analgesia was found to be 0.4% (95% Cl 0.1%-1.3%). Clinicians should be aware of this potentially high-risk subgroup of patients when developing and implementing a regional anesthetic care plan.