Crosby E T, Halpern S
Department of Anaesthesia, Women's College Hospital, University of Toronto, Ontario.
Can J Anaesth. 1989 Jul;36(4):445-7. doi: 10.1007/BF03005344.
We report the failure of a test dose of 3 ml lidocaine 1.5 per cent with 15 micrograms epinephrine to identify subdural placement of an epidural catheter in a parturient. Thirty-five minutes after injection of 13 ml lidocaine 1.5 per cent, intended to provide epidural analgesia, the patient developed an extensive sensory neural blockade. Some motor control was maintained and sympathetic block was incomplete. Blood pressure and oxygenation were easily supported with optimum positioning, fluids, ephedrine and oxygen by mask. The patient remained alert. The duration of neural blockade was approximately two hours. The patient underwent a second epidural for labour analgesia that was uneventful. There were no sequelae. Subdural injections are uncommon and unpredictable in their occurrence. Test doses do not consistently identify misplaced catheters. A negative response to a test dose does not guarantee that extensive neural blockade will not occur during epidural analgesia.
我们报告了在一名产妇中，使用含15微克肾上腺素的1.5% 3毫升利多卡因试验剂量未能识别硬膜外导管误入硬膜下的情况。在注射旨在提供硬膜外镇痛的1.5% 13毫升利多卡因35分钟后，患者出现广泛的感觉神经阻滞。部分运动控制得以保留，交感神经阻滞不完全。通过最佳体位、补液、麻黄碱和面罩给氧，血压和氧合情况易于维持。患者仍保持清醒。神经阻滞持续时间约为两小时。患者接受了第二次用于分娩镇痛的硬膜外麻醉，过程顺利。无后遗症。硬膜下注射并不常见，其发生具有不可预测性。试验剂量并不能始终识别导管位置不当的情况。对试验剂量的阴性反应并不能保证在硬膜外镇痛期间不会发生广泛的神经阻滞。
