natomy and Pathophysiology of Spinal Cord njury Associated With Regional Anesthesia nd Pain Medicine

r w t m s i a a t t t c t t p A u s L i he American Society of Regional Anesthesia and Pain Medicine (ASRA) convened a panel in April 005 to create a Practice Advisory on the Neurologic omplications of Regional Anesthesia and Pain Medcine. This review deals with the pathophysiology of pinal cord injury. The Practice Advisory recommenations are based on extensive review of existing anmal and human studies, case reports, pathophysiolgy, and expert opinion. The pathophysiology of spinal cord injury associted with anesthesia techniques is reviewed in epth, including mechanical trauma from direct eedle injury or mass lesions, vascular injury from irect needle trauma or spinal cord infarction, and eurotoxicity from local anesthetics and adjuvants. ight specific recommendations are offered that ay reduce the likelihood of spinal cord injury ssociated with regional anesthetic or pain mediine techniques. Spinal cord injuries associated with egional anesthesia and pain medicine are exceedngly rare. The Practice Advisory’s recommendaions may, in selected cases, reduce the likelihood of njury, but the vast majority of these injuries are either predictable nor preventable. Injury to the neuraxis as a consequence of regional nesthesia or pain medicine procedures is ultimately inked to anatomic and/or physiologic damage to the pinal cord, the spinal nerve roots, or their blood upply. Mechanisms of injury are sometimes identifible, as in the case of epidural hematoma, but can also