Adam J F, Fragment W, Castiel J, Lienhart A
Ann Fr Anesth Reanim. 1986;5(1):74-7. doi: 10.1016/s0750-7658(86)80128-9.
Lumbar epidural analgesia was performed in a 28 year old primigravida through a L2-L3 catheter. The first dose induced satisfactory analgesia for 1 h. After the second dose of 8 ml of 0.25 bupivacaine, the patient's systolic blood pressure fell from 110 to 80 mmHg. As vena caval compression can contribute to hypotension, the patient was immediately placed in the left lateral position and oxygen was administered through a mask. Rapid infusion of 250 ml of modified gelatin resulted in a prompt and lasting restoration of blood pressure to its initial level. The third dose of 8 ml of 0.25% bupivacaine produced satisfactory analgesia without any adverse effect. The last dose (4 ml of 0.50% bupivacaine administered with the patient in half sitting) gave a left-sided Horner's syndrome and weakness in the left arm. An epidurogram, performed through the catheter 2 h after delivery, with the patient lying supine, showed unilateral left spread ascending to upper thoracic levels with delayed spread toward the right lumbar epidural space. The troubles persisted 6 h after the final bupivacaine dose, then resolving completely.
在一名28岁初产妇身上通过L2-L3导管进行了腰椎硬膜外镇痛。首剂产生了1小时的满意镇痛效果。在给予第二剂8毫升0.25%布比卡因后，患者的收缩压从110毫米汞柱降至80毫米汞柱。由于腔静脉受压可能导致低血压，患者立即被置于左侧卧位，并通过面罩给予氧气。快速输注250毫升改良明胶后，血压迅速且持久地恢复到初始水平。第三剂8毫升0.25%布比卡因产生了满意的镇痛效果，且无任何不良反应。最后一剂（在患者半卧位时给予4毫升0.50%布比卡因）导致了左侧霍纳综合征和左臂无力。分娩后2小时通过导管进行的硬膜外造影显示，患者仰卧位时造影剂向左侧单侧扩散并向上延伸至胸段上部，向右侧腰段硬膜外间隙的扩散延迟。这些问题在最后一剂布比卡因给药后6小时仍持续存在，随后完全缓解。
