Editorial III

Authors:
  • PFP. D. W. Fettes
    P. D. W. Fettes
  • JWJ. A. W. Wildsmith
    J. A. W. Wildsmith
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Abstract
Concerns about neurological sequelae of spinal (intrathecal) anaesthesia are almost as old as the technique, but are considered to be preventable by an understanding of all the possible mechanisms of harm and a careful technique.1 Spinal anaesthesia is now used frequently for a wide range of surgery on the lower half of the body, but it is difficult to know just how safe it is as few prospective data have been collected in recent years. A French survey did note the total incidence of neurological sequelae to be six in 10 000 spinal anaesthetics, with permanent deficit occurring in less than one in 10 000,2 although the prospective nature of this study has been questioned.3 However, there have been rumours emanating for some time from UK medico‐legal circles of a disturbing number of cases of spinal cord damage associated with spinal anaesthesia. These rumours have been given substance by the publication by Reynolds4 of a series of seven patients, but with one recent estimate indicating that there may be at least 22 such.5 This may be a small number compared with the total number of spinal anaesthetics given, but the patients all have permanent and distressing symptoms. The nervous system has little capacity for repair, so it is vital that the causes are sought so that preventative strategies can be put in place.

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