The major advantage of spinal microcatheters is that they allow for smaller, titrated doses of anesthetics to be administered in order to minimize risk of cardiovascular and respiratory complications. These advantages are particularly important in older or high-risk patients who might not tolerate the abrupt sympathectomy that would result from a single-shot spinal.
Common complications include failure to thread the catheter, difficulty injecting local anesthetic that results in failed spinal, and neurological complications such as cauda equina syndrome (low back pain, sensory distribution in the saddle area, weakness of the legs, bowl and bladder dysfunction) or transient neurologic symptoms (TNS). The increased risk of cauda equina syndrome and TNS associated with the use of spinal microcatheters have led to spinal catheters smaller than 24 gauge being banned in the United States. There is some possibly that they increase the risk of post dural puncture headaches (conflicting data secondary to majority of use in patients’ that are over the age of 60 and have low incidence of post dural puncture headaches in general).