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Regional blockade in patients with a history of a seizure disorder.
Anesth Analg. 2009 Jul; 109(1):272-8.A&A

Abstract

BACKGROUND

Systemic local anesthetic toxicity is a potential complication in patients undergoing regional anesthesia, particularly during procedures requiring large doses of local anesthetic, such as epidurals, caudals, and peripheral nerve blocks. It is unknown whether patients with a history of a seizure disorder are at an increased risk of central nervous system toxicity (seizures) after local anesthetic administration.

METHODS

We retrospectively reviewed the medical records of all patients with documented history of a seizure disorder who underwent epidural, caudal, or peripheral nerve block from January 1, 1988 to December 31, 2001. Patient demographics, character of the seizure disorder, details of the regional procedure, and seizure activity in the perioperative period were recorded. The rate of seizure due to local anesthetic toxicity per 10,000 anesthetics was estimated using a point estimate and corresponding 95% confidence interval (CI).

RESULTS

During the 14-yr study period, 411 procedures in 335 patients with a seizure disorder were identified. Twenty-four patients experienced postoperative seizure activity. The timing of the most recent (preoperative) seizure was found to be significantly related to the likelihood of experiencing a postoperative seizure (P < 0.001). Based on the extended time interval between local anesthetic injection and/or termination of the infusion and the event, it was determined that the regional anesthetic was neither the primary etiology nor a contributing factor for the seizure in 19 of the 24 patients. In the remaining five patients, perioperative seizure activity was characteristic of their usual seizures. Although unlikely to be the cause of the seizure, local anesthetic toxicity could not be absolutely excluded as a contributing factor to the event in these five patients. Assuming that none of the seizures was related to local anesthetic toxicity the estimated incidence is 0 per 10,000 (95% CI 0-89 per 10,000). Conversely, if the seizures were related to local anesthetic toxicity in the five cases, the incidence is increased to 120 per 10,000 (95% CI 40-280 per 10,000).

CONCLUSIONS

We conclude that majority of seizures occurring in the perioperative period in patients with a preexisting seizure disorder are likely related to the patient's underlying condition and that regional anesthesia in these patients is not contraindicated. Furthermore, because the likelihood of a postoperative seizure is increased in patients with a recent seizure, it is essential to be prepared to treat seizure activity, regardless of the anesthetic and analgesic technique.

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Authors+Show Affiliations

Kopp SL
Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN 55905, USA. kopp.sandra@mayo.edu
Wynd KP
No affiliation info available
Horlocker TT
No affiliation info available
Hebl JR
No affiliation info available
Wilson JL
No affiliation info available

MeSH

AdolescentAdultAgedAged, 80 and overAnesthesia, ConductionChildChild, PreschoolEpilepsyFemaleHumansInfantMaleMiddle AgedNerve BlockRetrospective StudiesYoung Adult

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19535721

Citation

Kopp, Sandra L., et al. "Regional Blockade in Patients With a History of a Seizure Disorder." Anesthesia and Analgesia, vol. 109, no. 1, 2009, pp. 272-8.
Kopp SL, Wynd KP, Horlocker TT, et al. Regional blockade in patients with a history of a seizure disorder. Anesth Analg. 2009;109(1):272-8.
Kopp, S. L., Wynd, K. P., Horlocker, T. T., Hebl, J. R., & Wilson, J. L. (2009). Regional blockade in patients with a history of a seizure disorder. Anesthesia and Analgesia, 109(1), 272-8. https://doi.org/10.1213/ane.0b013e3181a832da
Kopp SL, et al. Regional Blockade in Patients With a History of a Seizure Disorder. Anesth Analg. 2009;109(1):272-8. PubMed PMID: 19535721.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Regional blockade in patients with a history of a seizure disorder. AU - Kopp,Sandra L, AU - Wynd,Kimberly P, AU - Horlocker,Terese T, AU - Hebl,James R, AU - Wilson,Jack L, PY - 2009/6/19/entrez PY - 2009/6/19/pubmed PY - 2009/7/22/medline SP - 272 EP - 8 JF - Anesthesia and analgesia JO - Anesth Analg VL - 109 IS - 1 N2 - BACKGROUND: Systemic local anesthetic toxicity is a potential complication in patients undergoing regional anesthesia, particularly during procedures requiring large doses of local anesthetic, such as epidurals, caudals, and peripheral nerve blocks. It is unknown whether patients with a history of a seizure disorder are at an increased risk of central nervous system toxicity (seizures) after local anesthetic administration. METHODS: We retrospectively reviewed the medical records of all patients with documented history of a seizure disorder who underwent epidural, caudal, or peripheral nerve block from January 1, 1988 to December 31, 2001. Patient demographics, character of the seizure disorder, details of the regional procedure, and seizure activity in the perioperative period were recorded. The rate of seizure due to local anesthetic toxicity per 10,000 anesthetics was estimated using a point estimate and corresponding 95% confidence interval (CI). RESULTS: During the 14-yr study period, 411 procedures in 335 patients with a seizure disorder were identified. Twenty-four patients experienced postoperative seizure activity. The timing of the most recent (preoperative) seizure was found to be significantly related to the likelihood of experiencing a postoperative seizure (P < 0.001). Based on the extended time interval between local anesthetic injection and/or termination of the infusion and the event, it was determined that the regional anesthetic was neither the primary etiology nor a contributing factor for the seizure in 19 of the 24 patients. In the remaining five patients, perioperative seizure activity was characteristic of their usual seizures. Although unlikely to be the cause of the seizure, local anesthetic toxicity could not be absolutely excluded as a contributing factor to the event in these five patients. Assuming that none of the seizures was related to local anesthetic toxicity the estimated incidence is 0 per 10,000 (95% CI 0-89 per 10,000). Conversely, if the seizures were related to local anesthetic toxicity in the five cases, the incidence is increased to 120 per 10,000 (95% CI 40-280 per 10,000). CONCLUSIONS: We conclude that majority of seizures occurring in the perioperative period in patients with a preexisting seizure disorder are likely related to the patient's underlying condition and that regional anesthesia in these patients is not contraindicated. Furthermore, because the likelihood of a postoperative seizure is increased in patients with a recent seizure, it is essential to be prepared to treat seizure activity, regardless of the anesthetic and analgesic technique. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/19535721/Regional_blockade_in_patients_with_a_history_of_a_seizure_disorder_ L2 - https://doi.org/10.1213/ane.0b013e3181a832da DB - PRIME DP - Unbound Medicine ER -