University of Kentucky, Lexington, KY 40536, USA.
Pain Physician. 2010 Jan-Feb;13(1):19-22.
Spinal cord stimulators are most often placed through a percutaneous approach using minimal sedation and local anesthesia to facilitate intraoperative testing. However, when leads need to be placed using a laminectomy incision additional anesthesia is required which can complicate intraoperative testing. There is no consensus as to the best anesthetic choice when laminectomy-placed leads are required.
We present 2 cases where spinal cord stimulator leads were implanted through a surgical laminectomy under sedation using dexmedetomidine infusion and local anesthesia to provide a cooperative patient for intraoperative testing.
Patient #1: A 40-year-old female with Complex Regional Pain Syndrome secondary to an automobile accident who had good pain control with a spinal cord stimulator until a lead fracture resulted in loss of stimulation. She required a laminectomy-placed lead which was implanted under dexmedetomidine infusion and local anesthesia. Patient #2: A 54-year-old female with Failed Back Syndrome who had good pain control until a lead fracture resulted in loss of stimulation. She underwent a laminectomy-placed lead, new battery pocket, and removal of the old system under a dexmedetomidine infusion and local anesthesia.
Report of only 2 cases.
The anesthetic management from a laminectomy-placed spinal cord stimulator can present a difficult choice. A general anesthetic or even deep sedation can provide good operative conditions but limits intraoperative testing or in the case of deep sedation risks losing the airway in the prone position. On the other hand, minimal sedation, which facilitates intraoperative testing, can make the surgical procedure extremely uncomfortable or even unbearable. Dexmedetomidine infusion and local anesthesia provide sedation for the operative portions while rendering the patient alert and cooperative during intraoperative testing.
脊髓刺激器通常通过经皮途径放置，使用最小镇静和局部麻醉来促进术中测试。然而，当需要通过椎板切开术放置导联时，需要额外的麻醉，这会使术中测试复杂化。当需要使用椎板切开术放置导联时，对于最佳麻醉选择尚无共识。
我们介绍了 2 例病例，其中脊髓刺激器导联在镇静下通过手术椎板切除术植入，使用右美托咪定输注和局部麻醉，为术中测试提供合作的患者。
患者 #1：一名 40 岁女性，因车祸导致复杂性区域疼痛综合征，脊髓刺激器可很好地控制疼痛，直到导联断裂导致刺激丧失。她需要进行椎板切开术放置导联，该导联在右美托咪定输注和局部麻醉下植入。患者 #2：一名 54 岁女性，患有失败的背部综合征，在导联断裂导致刺激丧失之前，她的疼痛得到了很好的控制。她在右美托咪定输注和局部麻醉下接受了椎板切开术放置导联、新电池袋和旧系统的移除。
仅报告了 2 例病例。
从椎板切开术放置的脊髓刺激器的麻醉管理可能是一个困难的选择。全身麻醉甚至深度镇静可以提供良好的手术条件，但限制了术中测试，或者在深度镇静的情况下，俯卧位时可能会失去气道。另一方面，最小镇静可以促进术中测试，但会使手术过程非常不舒服甚至难以忍受。右美托咪定输注和局部麻醉为手术部分提供镇静，同时使患者在术中测试期间保持清醒和合作。
