Rigler M L, Drasner K, Krejcie T C, Yelich S J, Scholnick F T, DeFontes J, Bohner D
Department of Anesthesia, University of California, San Francisco.
Anesth Analg. 1991 Mar;72(3):275-81. doi: 10.1213/00000539-199103000-00001.
Four cases of cauda equina syndrome occurring after continuous spinal anesthesia are reported. In all four cases, there was evidence of a focal sensory block and, to achieve adequate analgesia, a dose of local anesthetic was given that was greater than that usually administered with a single-injection technique. We postulate that the combination of maldistribution and a relatively high dose of local anesthetic resulted in neurotoxic injury. Suggestions that may reduce the potential for neurotoxicity are discussed. Use of a lower concentration and a "ceiling" or maximum dose of local anesthetic to establish the block should be considered. If maldistribution of local anesthetic is suspected (as indicated by a focal sensory block), the use of maneuvers to increase the spread of local anesthetic is recommended. If such maneuvers prove unsuccessful, the technique should be abandoned.
本文报告了4例连续脊麻后发生马尾综合征的病例。在所有4例病例中，均有局灶性感觉阻滞的证据，并且为了达到充分的镇痛效果，所给予的局部麻醉药剂量大于单次注射技术通常使用的剂量。我们推测，分布不均和相对高剂量的局部麻醉药共同作用导致了神经毒性损伤。文中讨论了可能降低神经毒性风险的建议。应考虑使用较低浓度的局部麻醉药和“封顶”或最大剂量来建立阻滞。如果怀疑局部麻醉药分布不均（如局灶性感觉阻滞所示），建议采用增加局部麻醉药扩散的操作方法。如果这些操作未成功，则应放弃该技术。
