Paraesthesiae and nerve damage following combined spinal epidural and spinal anaesthesia: a pilot survey

Concern has been expressed that recent changes in techniques of spinal bloc kade may have resulted in an increase in frequency of neurological sequelae . In order to make preliminary enquiries about anaesthetists' recent experi ences of neurological sequelae following spinal and combined spinal-epidura l anaesthesia, a questionnaire, covering numbers of procedures, needles use d and any neurological problems that had been encountered, was sent to the anaesthetist in charge of each obstetric centre on the Royal College of Obs tetricians and Gynaecologists' United Kingdom list. Replies were received f rom 222 of the 259 units, of whom 40 reported a total of 56 cases involving prolonged neurological sequelae, of which nine were probable obstetric pal sies, 18 could be attributed to the regional procedure (one instance of con us damage and the rest largely sensory disturbances) and 29 were of uncerta in origin, including a second conus damage. There was no obvious difference in incidence of problems associated with combined spinal-epidural vs. the single-shot spinal technique (odds ratio 1.14, confidence interval 0.53 to 2.46), or Sprotte vs. Whitacre atraumatic needle (odds ratio 1.40, confiden ce interval 0.64 to 3.08), A prospective survey, or better still, randomisa tion would be needed to verify these findings. (C) 2000 Halcourt Publishers Ltd.