Konishi Ruriko, Kawagoe Izumi, Kanai Masanori, Kimura Sonoko, Mitsuhata Hiromasa
Department of Anesthesiology and Pain Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo 136-0075.
Masui. 2010 Oct;59(10):1287-90.
A healthy 29-year-old woman received epidural block for severe lumbago in an outpatient clinic. Fifteen minutes after injection of mepivacaine 0.5% with dexamethasone into the epidural space, the patient complained of itching of eyelids followed by generalized pruritus. Hypotension, erythema and generalized urticaria were observed. Initial treatment was with 100% oxygen through face mask, and additional intravenous fluids, followed by administration of adrenaline, chlorpheniramine and dopamine. Cardiac ultrasound examination showed mildly impaired movement of inferior to septal wall. Her plasma histamine level was transiently elevated during the anaphylactic event; however the serum tryptase level was not. Biological assays for confirming the causative agent and cutaneous test were all negative, but clinical symptoms positivity showed nonimmunological anaphylactic reaction to mepivacaine or dexamethasone. This case report confirms the need for systematic allergological investigation in a case of immediate hypersensitivity reaction occurring during nerve block in patients who had even received similar nerve blocks repeatedly. Pain clinician should be aware of the possibility of anaphylactic reactions involving any drug or substance used for an outpatient.
一名29岁健康女性在门诊因严重腰痛接受硬膜外阻滞。在硬膜外腔注射0.5%甲哌卡因加地塞米松15分钟后，患者主诉眼睑瘙痒，随后出现全身瘙痒。观察到低血压、红斑和全身性荨麻疹。初始治疗为通过面罩给予100%氧气，补充静脉输液，随后给予肾上腺素、氯苯那敏和多巴胺。心脏超声检查显示下壁至间隔壁运动轻度受损。在过敏反应期间，她的血浆组胺水平短暂升高；然而血清类胰蛋白酶水平未升高。用于确认病因的生物学检测和皮肤试验均为阴性，但临床症状阳性表明对甲哌卡因或地塞米松有非免疫性过敏反应。本病例报告证实，对于即使反复接受类似神经阻滞的患者，在神经阻滞期间发生即刻超敏反应的病例，有必要进行系统的变态反应学调查。疼痛科医生应意识到门诊使用的任何药物或物质都可能发生过敏反应。
