Frohm Robert M, Raw Robert M, Haider Naeem, Boezaart André P
Regional Anesthesia Study Center of Iowa, Department of Anesthesia, University of Iowa, Iowa City, IA 52242, USA.
Reg Anesth Pain Med. 2006 May-Jun;31(3):279-81. doi: 10.1016/j.rapm.2005.02.010.
This report illustrates epidural spread after continuous cervical paravertebral block (CCPVB). By fluoroscopy, it also explains the mechanism of the complication.
A healthy 22-year-old male developed bilateral upper-extremity motor weakness immediately after placement of a continuous cervical paravertebral block for postoperative pain control after shoulder stabilization surgery. The tip of the stimulating catheter was demonstrated in the C7 neuroforamen. Contrast injected through the catheter demonstrated epidural spread. The contralateral block resolved after 4 hours and the patient suffered no respiratory embarrassment or other untoward sequelae.
Continuous cervical paravertebral block is a relatively new, but generally well-accepted, modality for postoperative pain control after major surgery to the upper limb. Epidural spread is recognized as a complication. In this particular case, medial placement of the catheter was possibly caused by unintentional medial direction of the bevel of the Tuohy needle. Meticulous attention to the direction of the needle bevel and early recognition and management of adverse events are mandatory. The same principles may apply for continuous thoracic, lumbar, and sacral paravertebral blocks.
本报告阐述了连续颈旁神经阻滞（CCPVB）后的硬膜外扩散情况。通过荧光镜检查，还解释了该并发症的机制。
一名健康的22岁男性在肩部稳定手术后接受连续颈旁神经阻滞以控制术后疼痛后，立即出现双侧上肢运动无力。刺激导管尖端位于C7神经孔。通过导管注入的造影剂显示有硬膜外扩散。对侧阻滞在4小时后消退，患者未出现呼吸窘迫或其他不良后遗症。
连续颈旁神经阻滞是一种相对较新但普遍被接受的用于上肢大手术后术后疼痛控制的方法。硬膜外扩散被认为是一种并发症。在这个特殊病例中，导管向内侧放置可能是由于Tuohy针斜面意外向内侧方向所致。必须密切关注针斜面的方向，并尽早识别和处理不良事件。同样的原则可能适用于连续胸段、腰段和骶段旁神经阻滞。
