Yamashita S, Joukou M, Kuramoto T
Department of Anesthesia, Tane General Hospital, Osaka.
Masui. 1990 Dec;39(12):1708-10.
A 74-yr-old man was scheduled for the biopsy of prostatic tumor under spinal anesthesia. Preoperative serologic test for syphilis was highly positive. Spinal anesthesia was performed in the sitting position, and 2 ml of hyperbaric Neo-percamine S (a mixture of 0.24% dibucaine and 0.12% T-caine) was administered uneventfully with the onset of warm sensation on the perineal region. Ten minutes later, however, he began to complain of severe lightning sensation on the feet. After giving pentazocine intravenously, the short cystoscopic procedure was completed. As a cause of severe pain, an erroneous anesthetic solution or direct neuronal injury had been excluded because of rapid and complete recovery after anesthesia. Two weeks later, he was scheduled for TUR-P. He again complained of severe lightning pain after the successful spinal anesthesia with the same anesthetic solution. Because the pain was not relieved by analgesics, he was then anesthetized with enflurane and N2O in oxygen, and there were no neurological complications after anesthesia. Several cases of severe pain during spinal anesthesia have been reported in patients with tabes dorsalis. Although the patient lacks clear symptoms of neurosyphilis, positive serologic examination for syphilis without any other possible causes suggests altered sensitivity of the spinal cord to anesthetic solutions.
一名74岁男性计划在脊髓麻醉下进行前列腺肿瘤活检。术前梅毒血清学检查呈强阳性。患者取坐位进行脊髓麻醉，顺利注入2 ml高压新喷他佐辛（一种由0.24%地布卡因和0.12%丁卡因组成的混合物），会阴部随即出现温热感。然而，10分钟后，他开始诉说足部有严重的闪电样感觉。静脉注射喷他佐辛后，简短的膀胱镜检查完成。由于麻醉后迅速且完全恢复，排除了麻醉溶液错误或直接神经损伤作为严重疼痛原因。两周后，他计划接受经尿道前列腺电切术（TUR-P）。在使用相同麻醉溶液成功进行脊髓麻醉后，他再次诉说有严重的闪电样疼痛。由于镇痛药无法缓解疼痛，随后给他使用恩氟烷和笑气-氧气麻醉，麻醉后未出现神经并发症。曾有几例脊髓痨患者在脊髓麻醉期间出现严重疼痛的报道。尽管该患者缺乏明确的神经梅毒症状，但梅毒血清学检查呈阳性且无其他可能原因提示脊髓对麻醉溶液的敏感性改变。
