Agarwal D, Mohta M, Tyagi A, Sethi A K
Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.
Anaesth Intensive Care. 2010 Jan;38(1):20-6. doi: 10.1177/0310057X1003800105.
There are a number of case reports describing accidental subdural block during the performance of subarachnoid or epidural anaesthesia. However it appears that subdural drug deposition remains a poorly understood complication of neuraxial anaesthesia. The clinical presentation may often be attributed to other causes. Subdural injection of local anaesthetic can present as high sensory block, sometimes even involving the cranial nerves due to extension of the subdural space into the cranium. The block is disproportionate to the amount of drug injected, often with sparing of sympathetic and motor fibres. On the other hand, the subdural deposition can also lead to failure of the intended block. The variable presentation can be explained by the anatomy of this space. High suspicion in the presence of predisposing factors and early detection could prevent further complications. This review aims at increasing awareness amongst anaesthetists about inadvertent subdural block. It reviews the relevant anatomy, incidence, predisposing factors, presentation, diagnosis and management of unintentional subdural block during the performance of neuraxial anaesthesia.
有许多病例报告描述了在蛛网膜下腔或硬膜外麻醉过程中意外发生的硬膜下阻滞。然而，硬膜下药物沉积似乎仍然是一种人们了解甚少的神经轴麻醉并发症。其临床表现常常可能归因于其他原因。硬膜下注射局部麻醉药可表现为高位感觉阻滞，有时甚至因硬膜下间隙延伸至颅腔而累及颅神经。这种阻滞与注射药物的量不成比例，交感神经和运动纤维常常未受影响。另一方面，硬膜下药物沉积也可导致预期阻滞失败。这种多变的表现可以用该间隙的解剖结构来解释。在存在易感因素时高度怀疑并早期发现可预防进一步的并发症。本综述旨在提高麻醉医生对意外硬膜下阻滞的认识。它回顾了神经轴麻醉过程中意外硬膜下阻滞的相关解剖、发生率、易感因素、表现、诊断和处理。
