Neurologic Complications After Chlorhexidine Antisepsis for Spinal Anesthesia

Background and Objectives: Recent reports of infectious complications after neuraxial procedures highlight the importance of scrupulous aseptic technique. Although chlorhexidine gluconate (CHG) has several advantages over other antiseptic agents; including a more rapid onset of action, an extended duration of effect, and rare bacterial resistance, it is not approved by the US Food and Drug Administration for use before lumbar puncture because of absence of clinical safety evidence. The objective of this retrospective cohort study was to test the hypothesis that the incidence of neurologic complications associated with spinal anesthesia after CHG skin antisepsis is not different than the known incidence of neurologic complications associated with spinal anesthesia. Methods: All patients 18 years or older who underwent spinal anesthesia at Mayo Clinic Rochester from 2006 to 2010 were identified. The primary outcome variable was the presence of any new or progressive neurologic deficit documentedwithin 7 days of spinal anesthesia. The etiology of a patient's neurologic complication was independently categorized as possibly or unlikely related to the spinal anesthetic by 3 investigators. Consensus among all reviewers was required for final category assignment. Results: A total of 11,095 patients received 12,465 spinal anesthetics during the study period. Overall, 57 cases (0.46%; 95% confidence interval, 0.34% Y0.58%) met criteria for neurologic complication. Spinal anesthesia was felt to be the possible etiology of 5 neurologic complications (0.04%; 95% confidence interval, 0.00%-0.08%); all completely resolved within 30 days. Discussion: The incidence of neurologic complications possibly associated with spinal anesthesia (0.04%) after CHG skin antisepsis is consistent with previous reports of neurologic complications after spinal anesthesia. These results support the hypothesis that CHG can be used for skin antisepsis before spinal placement without increasing the risk of neurologic complications attributed to the spinal anesthetic. (Reg Anesth Pain Med 2012; 37: 139-144)