Is neuraxial (regional anesthesia that numbs the lower spine) anesthesia contraindicated in patients with poliomyelitis (polio)?

Neuraxial Anesthesia in Poliomyelitis Patients

Neuraxial anesthesia is not contraindicated in patients with a history of poliomyelitis, and can be safely administered with appropriate precautions and risk assessment.

Risk Assessment for Neuraxial Anesthesia in Polio Patients

Contrary to historical concerns, evidence suggests that patients with a history of poliomyelitis can safely receive neuraxial anesthesia. A comprehensive retrospective study examining patients with preexisting central nervous system disorders found no new or worsening postoperative neurologic deficits following neuraxial anesthesia 1.

Key Considerations:

1. Disease Status and Neurological Assessment

   • Evaluate the extent of residual neurological deficits
   • Determine if patient has post-poliomyelitis syndrome (PPS)
   • Document baseline neurological function before proceeding

2. Respiratory Function

   • Assess respiratory reserve, as high neuraxial blocks may further compromise respiratory function in patients with preexisting respiratory weakness
   • Consider alternative approaches (such as peripheral nerve blocks) in patients with severely compromised respiratory function 2

3. Technical Approach

   • Use standard aseptic technique
   • Consider lower doses of local anesthetics initially to assess response
   • Monitor for hemodynamic changes, particularly hypotension

Evidence Supporting Safety

Multiple studies support the safety of neuraxial anesthesia in polio patients:

• A retrospective matched cohort study found no significant difference in pulmonary complications between polio survivors and control patients (17% vs 14%, odds ratio = 1.5; 95% CI, 0.7-3.3) 3

• A study of 123 patients with polio sequelae who underwent 162 surgical procedures, with neuraxial blocks used in 64.1% of cases, showed no worsening of neurological disorders during a 22-month follow-up period 4

• A case report of spinal anesthesia in a 70-year-old man with hemiparesis after poliomyelitis showed no progression of palsy, muscle atrophy, or autonomic dysfunction after the procedure 5

Practical Recommendations

• Start with thorough documentation of pre-existing deficits to avoid confusion about new versus pre-existing symptoms

• Consider using reduced doses of local anesthetics initially, as affected motor neurons may be more sensitive to local anesthetics

• Monitor closely for hemodynamic changes, particularly hypotension, which occurred in 1.23% of polio patients in one study 4

• Be prepared to manage potential complications including accidental dural puncture (0.61%), bradycardia (0.61%), and urinary retention (2.64%) 4

Special Considerations

For patients with significant respiratory compromise from polio, consider:

• Lower volume/concentration of local anesthetic to limit cephalad spread
• Alternative regional techniques such as peripheral nerve blocks 2
• Careful monitoring of respiratory function during and after the procedure

Conclusion

While historical teaching suggested avoiding neuraxial anesthesia in patients with preexisting neurological disorders like poliomyelitis, current evidence indicates that these techniques can be safely used with appropriate precautions. The benefits of avoiding general anesthesia may outweigh the theoretical risks in many polio patients, particularly those with respiratory compromise.