Halpenny D G, Loken R G, Williams J A
Department of Anaesthesia, Foothills Hospital, Calgary, Alberta.
Can J Anaesth. 1992 Jul;39(6):594-5. doi: 10.1007/BF03008325.
A patient is presented whose lumbar epidural catheter was found to lie in the paravertebral tissues during a right radical nephrectomy. The catheter had been placed with the patient awake and the procedure performed in a routine fashion without difficulty or indication of catheter malposition. Four ml of 2% CO2 lidocaine were initially injected as a test dose without any demonstrable effect. After the induction of general anaesthesia, fentanyl 100 mu and 0.25% bupivacaine 10 ml were injected slowly into the catheter. Previous studies suggest that transforaminal escape of an epidural catheter occurs after 1-6% of insertions. It may occur without nerve root symptoms during catheter placement. The authors recommend that epidural catheters be introduced whilst the patients are awake and an effective block demonstrated before induction of general anaesthesia.
本文报告了一例患者，在右侧根治性肾切除术期间发现其腰段硬膜外导管位于椎旁组织中。该导管是在患者清醒时放置的，手术按常规方式进行，没有困难，也没有导管位置不当的迹象。最初注射4毫升2%的二氧化碳利多卡因作为试验剂量，未显示任何效果。全身麻醉诱导后，将100微克芬太尼和10毫升0.25%布比卡因缓慢注入导管。先前的研究表明，硬膜外导管经椎间孔脱出的发生率为1%-6%。在导管放置过程中可能不出现神经根症状。作者建议在患者清醒时插入硬膜外导管，并在全身麻醉诱导前证实有效的阻滞。
