Department of Neurosurgery, Zuyderland Medical Center, Heerlen, the Netherlands.
Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands.
Acta Neurochir (Wien). 2024 Jul 8;166(1):284. doi: 10.1007/s00701-024-06173-0.
Post-operative pain after video-assisted thoracoscopic surgery is often treated using thoracic epidural analgesics or thoracic paravertebral analgesics. This article describes a case where a thoracic disc herniation is treated with a thoracoscopic microdiscectomy with post-operative thoracic epidural analgesics. The patient developed a bupivacaine pleural effusion which mimicked a hemothorax on computed tomography (CT).
The presence of bupivacaine in the pleural effusion was confirmed using a high performance liquid chromatography method.
The patient underwent a re-exploration to relieve the pleural effusion. The patient showed a long-term recovery similar to what can be expected from an uncomplicated thoracoscopic microdiscectomy.
A pleural effusion may occur when thoracic epidural analgesics are used in patents with a corridor between the pleural cavity and epidural space.
胸腔镜手术后的疼痛通常采用胸硬膜外镇痛或胸椎旁神经阻滞来治疗。本文介绍了一例使用胸腔镜微创手术联合术后胸硬膜外镇痛治疗的胸椎间盘突出症患者。该患者术后发生了布比卡因性胸腔积液，在 CT 上表现为血胸。
使用高效液相色谱法确定胸腔积液中布比卡因的存在。
患者接受了再次探查以缓解胸腔积液。患者的长期恢复情况与无并发症的胸腔镜微创手术相似。
在胸腔和硬膜外腔之间存在通道的患者中使用胸硬膜外镇痛可能会发生胸腔积液。
