Pollock Julia E
Virginia-Mason Medical Center, 1100 Ninth Avenue B2-AN Seattle, WA 98111, USA.
Best Pract Res Clin Anaesthesiol. 2003 Sep;17(3):471-84. doi: 10.1016/s1521-6896(02)00113-1.
Local anaesthetics have been placed in the intrathecal space for approximately 100 years. Currently used intrathecal local anaesthetics appear to be relatively benign on the basis of the low incidence of permanent neurological deficits. In large retrospective surveys of 4000-10 000 patients, the incidence of persistent neurological sequelae after subarachnoid anaesthesia varies between 0.01 and 0.7%. Since its introduction in 1948, hyperbaric 5% lidocaine has been used for millions of spinal anaesthetics. The predictable onset and limited duration of action have made lidocaine one of the most popular spinal anaesthetics currently available. Concern about the use of spinal lidocaine began in 1991 with published reports of cauda equina syndrome after continuous spinal anaesthesia. In 1993, Schneider published a case report of four patients undergoing spinal anaesthesia who postoperatively experienced aching and pain in the buttocks and lower extremities. This chapter reviews the neurotoxicity of spinal local anaesthetics, as well as the incidence, possible aetiology, and treatment of transient neurological symptoms after lidocaine spinal anaesthesia.
局部麻醉药用于鞘内已有约100年历史。基于永久性神经功能缺损的低发生率，目前使用的鞘内局部麻醉药似乎相对安全。在对4000 - 10000例患者的大型回顾性调查中，蛛网膜下腔麻醉后持续性神经后遗症的发生率在0.01%至0.7%之间。自1948年引入以来，5%的高比重利多卡因已用于数百万例脊髓麻醉。其起效可预测且作用持续时间有限，这使得利多卡因成为目前最常用的脊髓麻醉药之一。1991年，随着连续脊髓麻醉后马尾综合征的报道发表，人们开始关注脊髓利多卡因的使用。1993年，施奈德发表了一篇病例报告，4例接受脊髓麻醉的患者术后出现臀部和下肢疼痛。本章回顾了脊髓局部麻醉药的神经毒性，以及利多卡因脊髓麻醉后短暂性神经症状的发生率、可能病因和治疗方法。
