I read with interest the study by Rudant et al. on an increased risk to develop Guillain Barre syndrome (GBS) following surgery.1 No information is provided on the type of anesthesia preceding the development of GBS in this series and the association of the disorder with spinal/epidural anesthesia. The study fails to quote an early publication by Drs. Arnason and Asbury that reported 6 patients with GBS after surgery.2 Two of these 6 patients had surgery under spinal anesthesia. In a follow-up prospective study, Philips et al. described 8 patients who had a transient peripheral nervous system disorder following spinal anesthesia,3 and we reported 4 patients who developed GBS 1 to 2 weeks following epidural anesthesia.4 There are numerous reports of GBS following surgery, but the type of anesthesia is not addressed in a large study.
The mechanism linking surgery with the pathogenesis of GBS is elusive. The possibility that epidural/spinal anesthesia with local damage to nerve roots by the procedure, or by the anesthetic reagents, has to be considered. The present study might contain the possibility to look into this issue in detail. Is this information available?
References
Rudant J, Dupont A, Mikaeloff Y, et al. Surgery and risk of Guillain-Barré syndrome: A French nationwide epidemiologic study. Neurology 2018;91:e1220–e1227.
Phillips OC, Ebner H, Nelson AT, Black MH. Neurologic complications following spinal anesthesia with lidocaine: a prospective review of 10,440 cases. Anesthesiology 1969;30:284–289.
Steiner I, Argov Z, Cahan C, Abramsky O. Guillain-Barré syndrome after epidural anesthesia: direct nerve root damage may trigger disease. Neurology 1985;35:1473–1475.
I read with interest the study by Rudant et al. on an increased risk to develop Guillain Barre syndrome (GBS) following surgery.1 No information is provided on the type of anesthesia preceding the development of GBS in this series and the association of the disorder with spinal/epidural anesthesia. The study fails to quote an early publication by Drs. Arnason and Asbury that reported 6 patients with GBS after surgery.2 Two of these 6 patients had surgery under spinal anesthesia. In a follow-up prospective study, Philips et al. described 8 patients who had a transient peripheral nervous system disorder following spinal anesthesia,3 and we reported 4 patients who developed GBS 1 to 2 weeks following epidural anesthesia.4 There are numerous reports of GBS following surgery, but the type of anesthesia is not addressed in a large study.
The mechanism linking surgery with the pathogenesis of GBS is elusive. The possibility that epidural/spinal anesthesia with local damage to nerve roots by the procedure, or by the anesthetic reagents, has to be considered. The present study might contain the possibility to look into this issue in detail. Is this information available?
References
Footnotes
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