Komoda A, Yoda K, Saito A, Yamada E, Matsuda T, Yamashita T, Tojo H
Department of Anesthesiology, Kyoto 1st Red Cross Hospital.
Masui. 1994 Jul;43(7):1058-60.
A 36-year-old woman was scheduled for Cesarean section under spinal anesthesia. She was a carrier of hepatitis-B-virus and diabetic. She was complaining of low back pain. Spinal anesthesia was performed in the left lateral decubitus position. Because lumbar puncture in the midline was difficult, left paramedian approach was tried. Then she began to complain of right leg pain. Another attempt was made at other site, but her pain was not relieved. After confirming drop of blood-tinged cerebrospinal fluid, 0.3% dibucaine 2.0 ml was injected. Sensory anesthesia was assessed by pin-prick, but anesthesia was not effective. Then epidural catheter was inserted at Th12-L1 using median approach. She received 1.0% lidocaine 15 ml. However, sensory anesthesia was insufficient (Th4-Th12). Therefore O2-N2O was administered in addition to regional anesthesia. After the delivery, she still complained of low back pain. Later examination revealed metastatic bone tumor of L2 from hepatoma. This case suggests that in a patient with such incomplete spinal or epidural anesthesia and neurological finding, vertebral metastatic tumor should be ruled out.
一名36岁女性计划在脊髓麻醉下进行剖宫产。她是乙肝病毒携带者且患有糖尿病。她主诉腰痛。脊髓麻醉在左侧卧位进行。由于在中线进行腰椎穿刺困难，尝试了左旁正中入路。然后她开始诉说右腿疼痛。在其他部位又进行了一次尝试，但她的疼痛并未缓解。确认有血性脑脊液滴出后，注入0.3%丁卡因2.0毫升。通过针刺评估感觉麻醉，但麻醉效果不佳。然后采用正中入路在胸12 -腰1节段插入硬膜外导管。她接受了1.0%利多卡因15毫升。然而，感觉麻醉不足（胸4 -胸12）。因此，除区域麻醉外还给予了氧气 - 笑气。分娩后，她仍诉说腰痛。后来的检查发现肝癌转移至腰2椎体的骨肿瘤。该病例提示，对于存在这种不完全脊髓或硬膜外麻醉以及神经系统表现的患者，应排除椎体转移瘤。
