Lee Han-Il, Park Yong-Sook, Cho Tack-Geun, Park Seung-Won, Kwon Jeong-Taik, Kim Young-Baeg
Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, Korea.
J Korean Neurosurg Soc. 2012 Sep;52(3):228-33. doi: 10.3340/jkns.2012.52.3.228. Epub 2012 Sep 30.
Chronic neck or back pain can be managed with various procedures. Although these procedures are usually well-tolerated, a variety of side effects have been reported. In this study we reviewed cases of unexpected temporary adverse events after blocks and suggest possible causes.
We reviewed the records of patients treated with spinal pain blocks between December 2009 and January 2011. The types of blocks performed were medial branch blocks, interlaminar epidural blocks and transforaminal epidural blocks. During the first eight months of the study period (Group A), 2% mepivacaine HCL and triamcinolone was used, and during the last six months of the study period (Group B), mepivacaine was diluted to 1% with normal saline.
There were 704 procedures in 613 patients. Ten patients had 12 transient neurologic events. Nine patients were in Group A and one was in Group B. Transient complications occurred in four patients after cervical block and in eight patients after lumbar block. Side effects of lumbar spine blocks were associated with the concentration of mepivacaine (p<0.05). The likely causes were a high concentration of mepivacaine in five patients, inadvertent vascular injection in three patients, intrathecal leak of local anesthetics in one, and underlying conversion disorder in one.
Spinal pain blocks are a good option for relieving pain, but clinicians should always keep in mind the potential for development of inevitable complications. Careful history-taking, appropriate selection of the anesthetics, and using real-time fluoroscopy could help reduce the occurrence of adverse events.
慢性颈部或背部疼痛可通过多种方法进行治疗。尽管这些方法通常耐受性良好，但已报告了多种副作用。在本研究中，我们回顾了阻滞术后意外发生的临时不良事件病例，并提出了可能的原因。
我们回顾了2009年12月至2011年1月期间接受脊柱疼痛阻滞治疗的患者记录。所进行的阻滞类型包括内侧支阻滞、椎板间硬膜外阻滞和经椎间孔硬膜外阻滞。在研究期的前八个月（A组），使用了2%盐酸甲哌卡因和曲安奈德，在研究期的最后六个月（B组），甲哌卡因用生理盐水稀释至1%。
613例患者共进行了704次操作。10例患者发生了12次短暂性神经事件。9例患者在A组，1例在B组。4例患者在颈部阻滞后出现短暂并发症，8例患者在腰部阻滞后出现短暂并发症。腰椎阻滞的副作用与甲哌卡因浓度有关（p<0.05）。可能的原因是5例患者甲哌卡因浓度过高，3例患者意外血管内注射，1例患者局麻药鞘内渗漏，1例患者存在潜在的转换障碍。
脊柱疼痛阻滞是缓解疼痛的一个好选择，但临床医生应始终牢记不可避免并发症发生的可能性。仔细询问病史、适当选择麻醉剂以及使用实时透视有助于减少不良事件的发生。
