Dunbar S A, Katz N P
Department of Anesthesia and Pain Clinic, Brigham and Women's Hospital, Boston, USA.
Can J Anaesth. 1995 Mar;42(3):221-3. doi: 10.1007/BF03010681.
We report two unusual cases of postural, post-dural puncture upper thoracic interscapular backache, without headache, that were relieved by epidural blood patching. There is controversy concerning the aetiology of headache associated with the post-dural puncture syndrome. Mechanisms previously proposed have included traction on pain-sensitive intracranial structures such as the dura or blood vessels, or a vascular mechanism which may be adenosine-receptor mediated. These two cases suggest that traction on cervical or upper thoracic nerve roots should be considered as a possible mechanism of pain in the post-dural puncture syndrome.
我们报告了两例不寻常的病例，患者在硬膜穿刺后出现姿势性上胸段肩胛间区背痛，无头痛症状，经硬膜外血贴疗法后疼痛缓解。关于硬膜穿刺后综合征相关头痛的病因存在争议。先前提出的机制包括对硬脑膜或血管等疼痛敏感的颅内结构的牵拉，或可能由腺苷受体介导的血管机制。这两例病例表明，颈神经根或上胸神经根的牵拉应被视为硬膜穿刺后综合征疼痛的一种可能机制。
