Cauda equina syndrome has occasionally developed when an epidural dose was unintentionally injected into the subarachnoid space most commonly with which local anesthetic?

Cauda equina syndrome has occasionally developed when an epidural dose was unintentionally injected into the subarachnoid space most commonly with which local anesthetic?

• A. Bupivacaine
• B. Chloroprocaine
• C. Ropivacaine
• D. Lidocaine

Answer: (B)

Cauda equina syndrome from an inadvertent subarachnoid injection reflects neuraxial neurotoxicity where nerve roots in the cauda equina are irritated by the local anesthetic in the CSF. Among common neuraxial anesthetics, chloroprocaine has the strongest historical association with this complication when given intrathecally, mainly because older formulations contained preservatives (such as bisulfite or benzyl alcohol) that irritate meninges and nerve roots, leading to chemical arachnoiditis and the distal neurologic symptoms of CES. Modern preservative-free chloroprocaine has reduced this risk, but the relationship persists as a class effect of intrathecal exposure to local anesthetics, with chloroprocaine being the most notable culprit in past reports.

Cauda equina syndrome from an inadvertent subarachnoid injection reflects neuraxial neurotoxicity where nerve roots in the cauda equina are irritated by the local anesthetic in the CSF. Among common neuraxial anesthetics, chloroprocaine has the strongest historical association with this complication when given intrathecally, mainly because older formulations contained preservatives (such as bisulfite or benzyl alcohol) that irritate meninges and nerve roots, leading to chemical arachnoiditis and the distal neurologic symptoms of CES. Modern preservative-free chloroprocaine has reduced this risk, but the relationship persists as a class effect of intrathecal exposure to local anesthetics, with chloroprocaine being the most notable culprit in past reports.