Continuous spinal anesthesia: the Canadian perspective.

Abstract

BACKGROUND AND OBJECTIVES: Until the arrival of microcatheters, continuous spinal anesthesia was mainly restricted to elderly and high-risk patients. The introduction of microcatheters enabled the technique to be used in a wider range of patients. This paper describes the experiences of anesthetists in Canada with these catheters, and the changes in their practice since their withdrawal. METHODS: Anesthetists (those known to have experience with continuous spinal anesthesia, or to be regional anesthesia enthusiasts) across Canada were surveyed by telephone or mail. RESULTS: Of a total of 36 respondents, 25 had tried continuous spinal anesthesia with microcatheters. The majority had experience of only a few cases but a few reported larger series of hundreds of cases, Numerous technical difficulties with catheter insertion occurred, and problems with catheter breakage and neurologic deficit were reported. Some of these problems were reported to the Health Protection Branch, and, as a result of these reports and problems experienced in the United States, microcatheters were recalled in Canada soon after the FDA safety alert in the United States. CONCLUSIONS: Various techniques are being used instead of continuous spinal anesthesia with microcatheters, and only a few anesthetists favored their return.