Transient paraplegia in lumbar spine surgery-a potential complication following erector spinae plane block.

PURPOSE: Erector spinae plane block (ESPB) has gained popularity over recent years and is being increasingly used in spine surgery for pain management. To date, no major neurological complications have been reported. We present here two patients who developed transient postoperative paraplegia and discuss the possible causes of this phenomenon. METHODS: Patients, who underwent preoperative bilateral ESPB as an adjunct to general anesthesia for elective lumbar spine surgery at our institution between January 2017 and December 2020, were retrospectively identified. Among them, only patients who developed postoperative motor and sensory deficits were finally included. RESULTS: Overall, two patients [of 316 who underwent ESPB (0.6%)] developed complete motor and sensory deficits in bilateral lower limbs postoperatively. In both patients, the surgery was uncomplicated. Ninety minutes following recovery from general anesthesia, both patients showed gradual neurological recovery in a distal-to-proximal pattern, with complete motor recovery preceding the sensory improvement. Since the surgical procedure was performed at the cauda equine level, transient paraplegia in these patients could only attributed to ESPB. CONCLUSION: Transient paraplegia following ESPB (due to anterior spread of the local anesthetic agent into the epidural space) has never been reported, and both anesthetists and surgeons must be aware of this possible complication.

Reconfiguring the scope and practice of regional anesthesia in a pandemic: the COVID-19 perspective.

The COVID-19 outbreak is on the world. While many countries have imposed general lockdown, emergency services are continuing. Healthcare professionals have been infected with the virulent severe acute respiratory syndrome coronavirus-2 (SARS), which spreads by close contact and aerosols. The anesthesiologist is particularly vulnerable to aerosols while performing intubation and other airway related procedures. Regional anesthesia (RA) minimizes the need for airway manipulation and the risks of cross infection to other patients, and the healthcare personnel. In this context, for prioritizing RA over general anesthesia, wherever possible, a structured algorithmic approach is outlined. The role of percentage saturation of hemoglobin with oxygen (oxygen saturation), blood pressure and early use of point-of-care ultrasound in differential diagnosis and specific management is detailed. The perioperative anesthetic implications of multisystem manifestations of COVID-19, anesthetic management options, the scope of RA and considerations for its safe conduct in operating rooms is described. An outline for safe and rapid training of healthcare personnel, with an Entrustable Professional Activity framework for ascertaining the practice readiness among trained residents for RA in COVID-19, is suggested. These are the authors' experiences gained from the current pandemic and similar SARS, Middle East Respiratory Syndrome and influenza outbreaks in recent past faced by our authors in Singapore, India, Hong Kong and Canada.