Nerve damage following central neuraxial blockade: Is it avoidable?

Permanent nerve damage following central neuraxial blockade is a devastating but fortunately rare event. This lecture will briefly summarize the possible causes of nerve damage followed by a more detailed discussion of factors that may increase the risk of nerve damage and how to avoid them. Numerous mechanisms have been described that may result in major neurological complications. These can be subdivided as follows(1) (Table I, modified). With the latter in mind, Greene defined the following criteria for establishing that spinal anesthesia caused neurological damage(2):