Neurologic complications after placement of cerebrospinal fluid drainage catheters and needles in anesthetized patients: Implications for regional anesthesia

Subarachnoid or epidural needle placement in an anesthetized patient is con troversial because general anesthesia and muscle relaxation may mask neural trauma. However, placement of a needle or catheter in the subarachnoid spa ce for the purpose of cerebral spinal fluid (CSF) drainage is frequently pe rformed in anesthetized patients undergoing neurosurgery. The records from 530 consecutive transsphenoidal surgeries performed with lumbar CSF drainag e were reviewed to determine the types of neurologic complications attribut able to spinal drainage and their rates of occurrence. All patients were an esthetized during CSF drain placement. A 19-gauge malleable needle was plac ed in 473 (89%) patients. Subarachnoid catheters (20- or 16-gauge catheters placed via 18- or 14-gauge epidural needles, respectively) were placed in 17 (3%) patients. In 40 (8%) patients, the type of drain was unspecified. N o new neurologic deficits attributable to spinal drain insertion were detec ted in the immediate postoperative period or within 1 yr of surgery. Thirte en patients developed postdural puncture headache (2.5%, exact 95% confiden ce interval 1.3%-4.2%); seven required epidural blood patch (1.3%, 0.5%-2.7 %). The low incidence (0%, 0.0%-0.7%) of neurologic injury from spinal drai n insertion in anesthetized patients from this study is similar to the inci dence of neurologic complications historically reported for both CSF drain insertion and spinal anesthesia. Implications: The performance of regional anesthesia in an anesthetized patient is controversial due to the possibili ty of unrecognized nerve injury. We report no cases of nerve injury caused by the placement of cerebrospinal fluid drainage needles and catheters in 5 30 anesthetized patients undergoing neurosurgery.