We have reviewed the history, advantages and disadvantages, technique, materials, and problems associated with continuous spinal anaesthesia. While the recent reports of cauda equina syndrome after continuous spinal anaesthesia prompted the FDA to remove microcatheters from the USA market, continuous spinal anaesthesia with small-bore catheters is still used without complications in many countries. The mechanism that caused cauda equina syndrome to develop after continuous spinal anaesthesia may be the displacement of cerebrospinal fluid and exposure of the cauda equina to poorly distributed local anaesthetics that, at certain concentrations, are neurotoxic per se. We suggest steps that can be taken to prevent this from happening and we believe it is therefore possible to do continuous spinal anaesthesia safely and advantageously in selected patients.

Continuous spinal anesthesia has a fascinating history. The recent excitement about being able to use this method in young patients is now dampened by reports of cauda equina syndrome. It is hoped that limiting the concentrations and amounts of local anesthetic used for continuous spinal anesthesia will prevent this. All anesthetic methods have potential for complications and although continuous spinal anesthesia is no exception, it has much to offer.