Sollmann W P, Gaab M R, Panning B
Neurochirurgische Klinik, Medizinische Hochschule Hannover.
Reg Anaesth. 1987 Oct;10(4):121-4.
Epidural application of local anesthetics or opiates is commonly used for treatment of severe pain or arterial obstruction. We discuss two cases of complications following peridural anesthesia. As an acute complication, a lumbar epidural hematoma developed hours after placement of the catheter and caused sciatic pain and nearly complete paraplegia. The hemorrhage might have been promoted by heparinization. After decompressive hemilaminectomy the patient recovered but was disabled by a persistent paresis. The second patient suffered from renal failure, arterial obstruction, and phantom limb pain. A peridural catheter was kept in place for 6 weeks. Five months later the patient developed severe sciatica. Spinal computed tomography showed compression of the cauda at the L4/5 level (Fig.4) caused by an abscess that was opened and drained. After insertion of a gentamicin - PMMA - chain (Septopal), the wound healed primarily but the patient suffered from persistent pain. The incidence of vessel puncture after insertion of a peridural catheter is about 1%-10%. The risk of hemorrhage, perforation of the dura, and nerve root irritation is increased in scoliotic or elderly patients with a narrow spinal canal. Persistent pain after removal of the catheter is the most important sign. Although paraplegias following peridural catheterization can occur without anticoagulants, even low-dose heparinization is potentially dangerous. The risk of infectious complications after long-term peridural catheterization may be up to 20%. Hematogenous metastatic infection is more common in patients with malignancies or multiple risk factors than continuous immigration of bacteria. Epidural hematomas and spinal abscesses can cause disability and persistent neurological deficit in spite of aggressive surgical and antibiotic therapy.
硬膜外应用局部麻醉药或阿片类药物常用于治疗剧痛或动脉阻塞。我们讨论两例硬膜外麻醉后的并发症。作为急性并发症，一例患者在置管数小时后发生腰椎硬膜外血肿，导致坐骨神经痛和几乎完全性截瘫。出血可能因肝素化而加重。减压性半椎板切除术后患者恢复，但遗留持续性轻瘫而致残。第二例患者患有肾衰竭、动脉阻塞和幻肢痛。一根硬膜外导管留置了6周。5个月后患者出现严重坐骨神经痛。脊柱计算机断层扫描显示L4/5水平马尾受压（图4），由一个已切开引流的脓肿所致。插入庆大霉素 - 聚甲基丙烯酸甲酯链（Septopal）后，伤口一期愈合，但患者仍有持续性疼痛。硬膜外导管插入后血管穿刺的发生率约为1% - 10%。脊柱侧弯或椎管狭窄的老年患者发生出血、硬脊膜穿孔和神经根刺激的风险增加。拔除导管后持续性疼痛是最重要的体征。尽管硬膜外导管置入后即使没有使用抗凝剂也可能发生截瘫，但即使是低剂量肝素化也有潜在危险。长期硬膜外导管置入后感染并发症的风险可能高达20%。血行转移性感染在患有恶性肿瘤或有多种危险因素的患者中比细菌持续侵入更常见。尽管采取了积极的手术和抗生素治疗，硬膜外血肿和脊柱脓肿仍可导致残疾和持续性神经功能缺损。
