Lee Sang Hyun, Park Jae Woo, Hwang Byeong Mun
Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Korea.
Korean J Pain. 2015 Oct;28(4):280-3. doi: 10.3344/kjp.2015.28.4.280. Epub 2015 Oct 2.
Caudal epidural injection is a common intervention in patients with low back pain and sciatica. Even though the complications of fluoroscopically directed epidural injections are less frequent than in blind epidural injections, complications due to contrast media can occur. We report a case of anaphylactic shock immediately after injection of an intravenous nonionic contrast medium (iohexol) during the caudal epidural injection for low back pain and sciatica in a patient without a previous allergic history to ionic contrast media (ioxitalamate). Five minutes after the dye was injected, the patient began to experience dizziness, and the systolic blood pressure dropped to 60 mmHg. Subsequently, the patient exhibited a mild drowsy mental state. About 30 minutes after the subcutaneous injection of 0.2 mg epinephrine, the systolic blood pressure increased to 90 mmHg. The patient recovered without any sequela. Life-threatening complications after injection of intravenous contrast medium require immediate treatment.
骶管硬膜外注射是腰痛和坐骨神经痛患者的常见干预措施。尽管透视引导下硬膜外注射的并发症比盲目硬膜外注射少见，但仍可能发生造影剂相关并发症。我们报告一例在骶管硬膜外注射治疗腰痛和坐骨神经痛期间，静脉注射非离子型造影剂（碘海醇）后立即发生过敏性休克的病例，该患者既往对离子型造影剂（碘他拉酸盐）无过敏史。注射造影剂5分钟后，患者开始感到头晕，收缩压降至60 mmHg。随后，患者出现轻度嗜睡的精神状态。皮下注射0.2 mg肾上腺素约30分钟后，收缩压升至90 mmHg。患者康复且无任何后遗症。静脉注射造影剂后出现危及生命的并发症需要立即治疗。
