A considerable amount of patients scheduled for surgery suffers from concomitant neurologic disorders. Traditionally, they have been precluded from regional anesthesia for fear of the postulated ‘double crush’ phenomenon, which is an increased susceptibility for second site neuronal injury via needle trauma or local anesthetic neurotoxicity. But on the other hand, general anesthesia is posing significant risks too, concerning autonomic dysfunction, interference with neuromuscular blocking agents and other anesthetics, respiratory weakness and airway complications as well as postoperative delirium.
More recent publications, although sparse, have shown, that regional anesthesia can for example be used successfully without neurologic complications in patients with peripheral neuropathies like Charcot-Marie-Tooth, in neuromuscular junction diseases like myasthenia gravis or in central nervous system disorders like multiple sclerosis.
Still, new data indicates also that neuraxial anesthesia may increase the risk of new or worsening neurologic symptoms in preexisting significant spinal pathology and that diabetic nerves are truly more sensitive to local anesthetics.
This problem based learning discussion presents different clinical cases and reviews today´s evidence including both neuraxial- and peripheral block techniques. It doesn´t limit itself on answering the question if choosing regional anesthesia after an individual risk/benefit consideration makes sense here or not, but also tries to work out under which circumstances and especially how to do it most safely, if indicated.
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