Wedel, Denise J.

Neurologic complications associated with regional anesthesia and pain medicine practice are extremely rare. The ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine addresses the etiology, differential diagnosis, prevention, and treatment of these complications. This Advisory does not focus on hemorrhagic and infectious complications, because they have been addressed by other recent ASRA Practice Advisories. The current Practice Advisory offers recommendations to aid in the understanding and potential limitation of neurologic complications that may arise during the practice of regional anesthesia and pain medicine.

Cervical arthrography was performed on 13 patients with putative cervical facet symptoms. Under fluoroscopic control, injection of radiopaque dye, local anesthetic, and depot steroid into the affected joint capsule was performed without complication. Eleven of the 13 patients had partial to complete pain relief during the 2-week to 6-month followup period.

The current study was conducted to establish a reliable method for the placement of a long (>5 cm) catheter in the axillary neurovascular sheath, and to assess the effect of proximal catheter position on postoperative pain management by continuous bupivacaine infusion. In 20 patients scheduled for upper extremity surgery, a Portex® epidural catheter was advanced a mean distance of 12 cm in the axillary neurovascular sheath and its correct position verified by onset of upper extremity anesthesia and x-ray examination. After operation a continuous infusion of bupivacaine 0.125% was initiated through this catheter. Excellent pain relief (score of 0-1 as evaluated on a visual analogue scale of 0 to 10), and sympathetic blockade was achieved in all patients with an average rate of bupivacaine administration of 7 ml/hr. Additionally administered systemic narcotics were in a mean range of 3-10 mg of morphine/day. Catheters remained in place for an average of 3.7 days. Catheter tips cultured on removal of the catheter (n = 11) yielded negative cultures in eight cases (placement 3.6 ± 0.6 days), and positive cultures in three cases (placement 8.6 ± 2.2 days, mean ± SE). No signs of local or systemic infection were noted in any patient and no specific antibiotic therapy was initiated. This technique is recommended for postoperative analgesia in selected patients. In this study there was a low risk of catheter displacement and no evidence of local anesthetic toxicity. Limiting the duration of continuous axillary catheter infusion to 4 days may minimize the risk of infection.