What is TNS?
Transient neurological symptoms that is defined as pain or dysesthesia or both that occurs in the legs or buttocks after recovery from a spinal anesthetic
What is the onset and duration of TNS?
It appears within the first 24 hours after full recovery from a spinal, and resolves completely within 72 hours
what local anesthetis are associated with TNS?
lidocaine and mepivacaine
what surgical position during surgery is associated with TNS?
what surgical procedure is assocatied with high rates of TNS?
Does decreasing the concentration of lidocaine decrease the risk of TNS?
no, studies have shown that this is not effective
what are the most common treatment options for TNS?
opioids,NSAIDS (most successful), muscle relaxers, and symptomatic therapy (heating pads/elevation)
What local anesthetic is associated with severe back pain after epidural anesthesia?
what is the cause of back pain associated with cholorprocaine-mpf?
EDTA causes chelation of Ca ions in lumbar muscles.
what is the strongest risk factor associated with chloroprocaine and back pain?
total volume and concentration of chloroprocaine correlate with the incidence and severity of back pain
What is the duration of back pain associated with chloroprocaine?
Where does hemorrhaging usually occur during centroaxial neuroblockade?
Bleeding most often occurs in the epidural space due to the epidural venous plexus.
What are the signs and symptoms of epidural hematomas?
Onset within 0 to 2 days with back pain, sensory deficit, and changes in bowel and bladder function
what approach is most likely to have an epidural hematoma, an epidural or spinal anesthetic?
An epidural anesthetic 1:150k, compared to 1:220k in spinals
what is the expected onset of back pain associated with chloroprocaine?
within 30 minutes after regression of anesthesia
What are examples of superficial infections associated with centroaxial anesthesia? How likely are they to cause neurological impairment?
Present as local tissue edema, erythema, drainage, and fever. THey usually don't cause any impairment
What are the clinical manifestations of an epidural abscess?
Onset 2-7 days. Characterized by severe localized back pain, neurological disturbances, and fever with leukocytosis
what are the usual causes of epidural abscesses?
infections of the skin, soft tissue, spine, or to hematogenous spread to the epidural space
what bacteria is the most common cause of epidural abscess?
describe adhesive arachnoiditis
an acute, local inflammatory response followed by a proliferative phase characterized by fibrosis, adhesion, and scarring that involves the arachnoid layer of the meningeal sac
what drugs are given to treat adhesive arachnoiditis?
methylprednisone and NSAIDS
Clinical manifestations of cauda equina syndrome
Due to small autonomic fibers in the terminal portion of the spinal cord being affected: autonomic insufficency, changes in bowel/bladder function, paraplegia, alterations in pinprick sensation, temp, and proprioception
Why are nerve fibers in the cauda equina vulnerable to injury from high dose local anesthetics?
because they lack any protective sheath
what baracity of local anesthetics is most associated with cauda equina syndrome?
Hyperbaric local anesthetics because of pooling in the area of the cauda equina nerve roots
How can cauda equina syndrome be avoided?
Avoid high concentrations of local, wait 10 minutes between failed spinal attempts, choose L2-3 if a hyperbaric solution is to be used to enhance cephalad spread