NERVE INJURIES FROM CENTRAL NERVE BLOCKAD E AND REGIONAL ANESTHESIA

Neural damage is a possible complication of central nerve blockade and regional anaesthesia. Damage may be caused by ischaemic, mechanical o r chemical mechanisms, which may occur either alone or in combination. Neural ischaemia may be caused by 1) prolonged and severe arterial hy potension, which compromises blood supply to the cord, 2) a spinal hae matoma whose main etiological factor is a coagulation abnormality and 3) an intraneural injection. Mechanical trauma by the needle bevel is an important factor of neuropathy, particularly when searching for par aesthesiae. Neurological complications may also result from a direct n eurotoxic effect of local anaesthetic agents which is concentration an d dose-dependent. Better understanding of these mechanisms will permit the establishment of reliable bases for new preventive strategies.