Kavlock Renae, Ting Paul H
Department of Anesthesiology, University of Virginia Health Center, Charlottesville, Virginia, USA.
BMC Anesthesiol. 2004 Jan 16;4(1):1. doi: 10.1186/1471-2253-4-1.
We report a case of a patient with apparent resistance to local anesthetics. While similar cases of failure of regional anesthetics are often attributed to technical failure, the overall clinical presentation and history of this patient suggests a true resistance to local anesthetics. CASE PRESENTATION: This patient presented for elective cesarean section and the decision for regional anesthesia was made. While attempting to place an epidural, the patient failed to achieve adequate skin analgesia despite multiple attempts at local infiltration. When a spinal was ultimately placed, sensory or motor blockade was not obtained despite no evidence of technical problems with technique. Further questioning revealed multiple prior episodes of local anesthetic failure in this patient. CONCLUSIONS: While the failure rate of spinal anesthesia has been shown range from 4-13% and is often attributed to technical failure, elements of this particular case suggest a true resistance to local anesthetics.
我们报告一例对局部麻醉药明显耐药的患者。虽然区域麻醉失败的类似病例通常归因于技术失误，但该患者的整体临床表现和病史提示对局部麻醉药存在真正的耐药性。病例介绍：该患者因择期剖宫产就诊，决定采用区域麻醉。在尝试置入硬膜外导管时，尽管多次进行局部浸润麻醉，患者仍未获得足够的皮肤镇痛效果。最终进行脊髓麻醉时，尽管没有技术问题的证据，但仍未获得感觉或运动阻滞。进一步询问发现该患者既往有多次局部麻醉失败的情况。结论：虽然脊髓麻醉的失败率已显示在4%至13%之间，且通常归因于技术失误，但该特殊病例的一些因素提示对局部麻醉药存在真正的耐药性。
