Honda Jun, Yamazaki Yuki, Yakushiji Tatsumi, Hirata Hinako, Inoue Satoki
Department of Anesthesiology, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan.
Department of Anesthesiology, Iwaki City Medical Center, 16, Kusehara, Mimaya-machi, Uchigo, Iwaki, Fukushima, 973-8555, Japan.
JA Clin Rep. 2022 Oct 29;8(1):89. doi: 10.1186/s40981-022-00579-4.
We present a case of inadequate spinal anesthesia possibly due to cerebrospinal fluid (CSF) leakage into the epidural space caused by accidental dural puncture (ADP).
A 28-year-old woman with twin pregnancy underwent a cesarean section. She was scheduled to undergo combined spinal-epidural anesthesia (CSEA). Hyperbaric bupivacaine 9 mg with fentanyl 15 μg, with an additional bupivacaine 5 mg was administered from the L3/4 interspace for spinal anesthesia after repeated ADP at T12/L1; however, analgesia level was only up to T12. Insufficient analgesia level would be attributed to leakage of bupivacaine into the epidural space with the CSF via the injured dura. Planned surgery was performed under general anesthesia and completed uneventfully.
In spinal anesthesia performed after ADP in pregnant women, the anesthesia level may not increase as expected if there is a large amount of CSF leakage.
我们报告一例可能因意外硬膜穿刺（ADP）导致脑脊液（CSF）漏入硬膜外间隙而引起的脊髓麻醉不足病例。
一名怀有双胞胎的28岁女性接受剖宫产手术。她计划接受腰麻-硬膜外联合麻醉（CSEA）。在T12/L1反复发生ADP后，于L3/4间隙给予9 mg重比重布比卡因加15 μg芬太尼用于脊髓麻醉，另加5 mg布比卡因；然而，镇痛平面仅达T12。镇痛平面不足归因于布比卡因通过受损硬膜与脑脊液一起漏入硬膜外间隙。计划的手术在全身麻醉下进行，顺利完成。
在孕妇发生ADP后进行脊髓麻醉时，如果有大量脑脊液漏出，麻醉平面可能不会如预期那样升高。
