Kato M, Tada F, Abe T, Okada T, Mori K, Go R, Kohyama A
Department of Anesthesiology, Komatsushima Red Cross Hospital.
Masui. 2000 Sep;49(9):1021-3.
A 71-year-old woman with diabetic neuropathy who had undergone amputation of the right lower leg for diabetic gangrene 4 years previously, experienced severe lightning pain in both legs during spinal anesthesia. She was scheduled for skin grafting for a burn ulcer on her left foot. Her preoperative physical examination revealed hypesthesia in both legs due to diabetic neuropathy. Spinal anesthesia was performed with a combined spinal-epidural needle at the L 4-5 interspace using 2.0 ml of 0.3% hyperbaric dibucaine in the left lateral position. The region of hypesthesia was spread below Th 4. Ten minutes later, she complained of severe lightning pain in both legs and midazolam 1 mg was administered intravenously against agitation. The severe lightning pain diminished after the administration of pentazocine 7.5 mg intravenously in the recovery room. There was no worsening of neurological findings 5 hours later when the effect of spinal anesthesia disappeared. This clinical picture seems to be different from that of reported cases of phantom limb pain during spinal anesthesia in which severe lightning pain occurred in both legs. This case suggests that patients with diabetic neuropathy might develop severe lightning pain during spinal anesthesia using dibucaine.
一名71岁患有糖尿病神经病变的女性，4年前因糖尿病坏疽接受了右下肢截肢手术，在脊髓麻醉期间双腿出现严重的闪电样疼痛。她计划接受左脚烧伤溃疡的植皮手术。术前体格检查发现，由于糖尿病神经病变，她的双腿感觉减退。在左侧卧位下，于L 4-5椎间隙使用联合腰麻-硬膜外针进行脊髓麻醉，注入2.0毫升0.3%的高压丁卡因。感觉减退区域蔓延至胸4以下。10分钟后，她诉说双腿出现严重的闪电样疼痛，静脉注射1毫克咪达唑仑以缓解躁动。在恢复室静脉注射7.5毫克喷他佐辛后，严重的闪电样疼痛减轻。5小时后脊髓麻醉效果消失时，神经学检查结果未恶化。这种临床表现似乎与报道的脊髓麻醉期间幻肢痛病例不同，那些病例中双腿出现严重的闪电样疼痛。该病例提示，使用丁卡因进行脊髓麻醉时，糖尿病神经病变患者可能会出现严重的闪电样疼痛。
