Wakata Ryuichi, Inoue Mihou, Kasai Kyomi
Department of Anesthesiology, Adachi Hospital, Kyoto, JPN.
Cureus. 2024 Nov 27;16(11):e74568. doi: 10.7759/cureus.74568. eCollection 2024 Nov.
Lumbar epidural anesthesia is widely used for labor epidural analgesia (LEA), but it often results in insufficient analgesia in the sacral region. We report a case where we performed LEA using lumbar epidural anesthesia, and an asymptomatic sacral perineural cyst was considered the potential cause of inadequate analgesia in the sacral region. A 33-year-old primigravida was admitted with premature rupture of membranes. Lumbar epidural anesthesia was performed after spontaneous labor occurred. Labor epidural analgesia alleviated the pain, but it worsened again during the second stage of labor. No nerve blockade in the sacral region was confirmed. Despite catheter adjustment and additional medication, pain relief was not achieved. A review of past imaging studies revealed an asymptomatic sacral perineural cyst. A sacral perineural cyst can be considered one of the causes of insufficient analgesia in the sacral region during LEA. We propose strategies for managing similar cases and emphasize the importance of pre-anesthetic imaging review when available.
腰段硬膜外麻醉广泛用于分娩硬膜外镇痛（LEA），但它常常导致骶部镇痛不足。我们报告一例使用腰段硬膜外麻醉进行LEA的病例，一个无症状的骶部神经周囊肿被认为是骶部镇痛不足的潜在原因。一名33岁初产妇因胎膜早破入院。自发宫缩后实施腰段硬膜外麻醉。分娩硬膜外镇痛缓解了疼痛，但在第二产程中疼痛再次加重。未证实骶部存在神经阻滞。尽管调整了导管并追加了药物，但仍未实现疼痛缓解。回顾既往影像学检查发现一个无症状的骶部神经周囊肿。骶部神经周囊肿可被视为LEA期间骶部镇痛不足的原因之一。我们提出了处理类似病例的策略，并强调在有条件时进行麻醉前影像学检查的重要性。
