Alshoubi Abdalhai, Newhide Danny
Clinical Anesthesiology and Critical Care Medicine, St. Joseph's Medical Center, Stockton, USA.
Anesthesiology and Critical Care, St. Joseph's Medical Center/Dignity Health, Stockton, USA.
Cureus. 2022 Jul 25;14(7):e27252. doi: 10.7759/cureus.27252. eCollection 2022 Jul.
Epidural neuraxial analgesia is a standard procedure for pain control during labor and delivery. One rare complication is accidental epidural catheter placement in the subdural space, a potential space between the arachnoid and dura membranes. The incidence of the subdural blockade during neuraxial block is unknown. The subdural block suspicion arises when the clinical signs and symptoms do not fit epidural or subarachnoid local anesthetic injection. The clinical picture includes delayed or gradual onset, extensive sensory block with minimal motor block, hypotension more than an epidural neuraxial block, and less than spinal neuraxial block, and it can rarely track intracranially and causes dyspnea and loss of consciousness. In this article, we report a case of inadvertent subdural catheter placement that was diagnosed clinically with unexpectedly high block involving the upper extremities. No radiological confirmation was used for the diagnosis.
硬膜外神经轴索镇痛是分娩期间控制疼痛的标准操作。一种罕见的并发症是硬膜外导管意外置入硬膜下间隙,这是蛛网膜和硬脑膜之间的一个潜在间隙。神经轴索阻滞期间硬膜下阻滞的发生率尚不清楚。当临床体征和症状不符合硬膜外或蛛网膜下腔局部麻醉注射时,就会怀疑发生硬膜下阻滞。临床表现包括起效延迟或逐渐起效、广泛的感觉阻滞且运动阻滞轻微、低血压程度超过硬膜外神经轴索阻滞且低于脊髓神经轴索阻滞,并且很少会向颅内蔓延并导致呼吸困难和意识丧失。在本文中,我们报告了一例意外硬膜下导管置入病例,该病例通过临床诊断为累及上肢的意外高位阻滞。诊断未采用放射学确认。