Gregoretti S
Minerva Anestesiol. 1980 Mar;46(3):437-9.
A case of high spinal anesthesia complicating an interscalene brachial plexus block is described. After an apparently straightforward location of the plexus with good paresthesias, the injection of 10 ml of local anesthetic caused a high spinal block whose main feature was apnea. The patient retained his consciousness until he was anesthetized with thiopentone and N2O-O2 and had a vivid recollection of the accident. The patient resumed spontaneous breathing after about 1 hour of artificial ventilation and 2 hours later at the end of surgery he was fully conscious without any residual sensory or motor block. The clinical picture compared to previous cases reported in the literature is commented on. A possible subarachnoid spread of the local anesthetic via the perineural space following intraneural injection is discussed. The author advocates the use of needles no longer than 1 inch for the interscalene approach to the brachial plexus.
本文描述了1例肌间沟臂丛神经阻滞并发高位脊髓麻醉的病例。在看似顺利定位神经丛且感觉异常良好后，注射10 ml局部麻醉药导致了高位脊髓阻滞，其主要特征为呼吸暂停。患者在使用硫喷妥钠和N2O - O2麻醉前一直保持清醒，并对该意外事件有清晰的记忆。经过约1小时的人工通气，患者恢复自主呼吸，2小时后手术结束时，患者完全清醒，无任何感觉或运动阻滞残留。文中对与既往文献报道病例相比的临床表现进行了评论。讨论了局部麻醉药经神经内注射后通过神经周间隙蛛网膜下腔扩散的可能性。作者主张肌间沟臂丛神经阻滞时使用不超过1英寸的穿刺针。
