Incidence of Paresthesia, Neurological Complications and Cardiocirculatory Changes after Thoracic Spinal Anesthesia: A Multicentric Retrospective Study

Introduction: Various analgesic management strategies have evolved, often the regional analgesic techniques being favored over the systemic administration of opioids. Most anesthesiologists use thoracic epidural, which has a 0.75% incidence of accidental perforation. However, they are reluctant to consider higher levels for spinal anesthesia because of the possibility of direct spinal cord injury.

Aim: The main objective of this retrospective study was to evaluate the incidence of paresthesia and neurological complications, as well as cardiocirculatory changes after thoracic spinal anesthesia.

Methods: This retrospective study of patients undergoing thoracic spinal anesthesia evaluated the following parameters: needle types, needle insertion, puncture position (sitting or lateral decubitus), thoracic puncture level, presence of cerebrospinal fluid (CSF) in the needle hub, type of anesthetic, latency, motor block, incidence of bradycardia and hypotension, paresthesia (duration) and neurological complications. This study conducted a retrospective audit, between January 2007 and December 2019. This study reviewed the record sheets of patients who experienced paresthesia for thoracic spinal anesthesia with two types of needles of the same gauge, isobaric and hyperbaric 0.5% bupivacaine and puncture in the sitting or left lateral position, and median and paramedian insertion.

Results: Paresthesias occurred in 5.9% of patients. In this observation, 41 patients experienced a paresthesia with cut needle compared with 43 patients with a pencil point, without statistical difference. All paresthesias were transient and lasted a maximum of three days. No sequelae neurologic were observed in all patients during this study. Bradycardia occurred in 3.1% of the patients and hypotension in 13.2% of the patients, easily corrected by the use of atropine and vasopressor.

Conclusion: All 84 paresthesias observed in this study were associated with free flow of CSF when the stylet was removed from the needles. No association was found between the type of spinal needle and the incidence of paresthesias. This study with 1,406 patients showed that thoracic spinal anesthesia is safe and without neurological sequelae, with a puncture between T8 and T11. If the anesthetist has an adequate knowledge of the relevant modern anatomy, physiology and pharmacology, safe and satisfactory anesthesia can easily be obtained to the mutual satisfaction of the patient, surgeon and anesthetist.