Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia.
St John of God Hospital, Subiaco, Australia.
Anaesth Intensive Care. 2021 Jan;49(1):70-73. doi: 10.1177/0310057X20973046. Epub 2021 Jan 27.
This case report describes a patient who developed allergic contact dermatitis to a chlorhexidine skin preparation applied for a transversus abdominis plane block, but not to a different chlorhexidine solution applied to the surgical field. The patient had presented for an elective inguinal hernia repair. He had a known history of anaphylaxis to non-steroidal anti-inflammatory medication but was otherwise well. The surgery was completed uneventfully. Three or four days postoperatively, the patient developed a rash at the site where chlorhexidine skin preparation had been used to prepare the skin for the transversus abdominis plane block. The rash had well-demarcated edges and exactly matched the distribution of the previously applied skin preparation. No rash was present at the surgical site, which had been prepared with a different chlorhexidine-containing solution. The rash gradually resolved over several weeks with the application of topical corticosteroids. The patient was otherwise completely well with no evidence of infection or any other systemic illness. The skin preparations differed in the dyes and alcohols that they contained. The dyes or alcohol in the preparation for the transversus abdominis plane block were therefore considered the likely cause of this patient's allergic reaction. Dyes and alcohols should be considered as a cause of skin allergy in the perioperative setting.
本病例报告描述了一位患者在接受腹横肌平面阻滞时应用洗必泰皮肤制剂后发生过敏接触性皮炎，但应用于手术区域的不同洗必泰溶液则未出现过敏反应。该患者因择期腹股沟疝修补术就诊。他已知对非甾体抗炎药物过敏，但除此以外健康状况良好。手术过程顺利。术后 3 至 4 天，患者在接受腹横肌平面阻滞的皮肤准备中应用洗必泰皮肤制剂的部位出现皮疹。皮疹边界清晰，与先前应用的皮肤制剂完全吻合。在应用不同含洗必泰溶液进行准备的手术部位则未见皮疹。应用局部皮质类固醇后，皮疹在数周内逐渐消退。患者全身状况良好，无感染或任何其他系统性疾病的证据。皮肤制剂在所含染料和酒精方面存在差异。因此，腹横肌平面阻滞制剂中的染料或酒精被认为是导致该患者过敏反应的原因。染料和酒精应被视为围手术期皮肤过敏的原因。
