Elsharkawy Hesham, Khanna Ashish K, Barsoum Sabri
Anesthesiology Institute and Outcomes Research, Cleveland Clinic Foundation, 9500, Euclid Avenue, Cleveland, Ohio, OH 44195, USA ; Cleveland Clinic Learner College of Medicine of Case Western Reserve University, Cleveland, Ohio, OH 44195, USA.
Anesthesiology Institute, Cleveland Clinic Foundation, 9500, Euclid Avenue, Cleveland, Ohio, OH 44195, USA.
Case Rep Med. 2013;2013:751648. doi: 10.1155/2013/751648. Epub 2013 Nov 14.
Combined spinal epidural (CSE) can provide excellent labor analgesia. Subdural block is also a potential but rare complication of attempted epidural placement during a CSE procedure, which may present as a block that is usually patchy in nature, with a component of sensory and/or motor deficit and a variable duration of action. In addition, a conversion disorder or a functional neurological disorder has been described with epidural and spinal anesthesia in obstetric patients. In this clinical report, we describe a 33-year-old G4P3 at 40 weeks gestation that received an unintentional subdural block as part of her labor analgesia and after an uneventful caesarean delivery presented with a conversion disorder. The rarity of the association between a subdural block and a conversion disorder complicated by the fact that the neurological deficit produced by the subdural block and that produced by a conversion disorder are similar in distribution made the clinical presentation and diagnosis a challenge for the obstetric anesthesia team. A functional neurological disorder of this nature complicating a subdural block in an obstetric anesthesia clinical practice has not been described so far.
腰麻-硬膜外联合麻醉（CSE）可提供出色的分娩镇痛。硬膜下阻滞也是CSE操作过程中硬膜外穿刺尝试的一种潜在但罕见的并发症，其表现通常为性质上呈片状的阻滞，伴有感觉和/或运动功能障碍的成分，且作用持续时间可变。此外，产科患者在硬膜外麻醉和腰麻时曾出现过转换障碍或功能性神经障碍。在本临床报告中，我们描述了一名33岁、孕40周的经产妇，她在分娩镇痛过程中意外发生硬膜下阻滞，在剖宫产顺利完成后出现了转换障碍。硬膜下阻滞与转换障碍之间关联的罕见性，再加上硬膜下阻滞产生的神经功能缺损与转换障碍产生的神经功能缺损在分布上相似，使得临床表现和诊断对产科麻醉团队来说是一项挑战。迄今为止，尚未有这种性质的功能性神经障碍在产科麻醉临床实践中使硬膜下阻滞复杂化的相关描述。
