Chhibber A K, Lustik S J
Department of Anesthesiology, University of Rochester Medical Center, Strong Memorial Hospital, NY 14642, USA.
Reg Anesth. 1996 Jul-Aug;21(4):355-7.
A case of unexpected neurologic deficit of the left lower extremity following a successful spinal block is reported.
A spinal block was performed in a 45-year-old woman with a 25-gauge Whitaker needle at the L3-L4 interspace. After establishing flow of clear cerebrospinal fluid, 1.6 mL of 0.75% bupivacaine was injected into the subarachnoid space. The patient had a good motor and sensory block (level T4), and she underwent uneventful extracorporeal shock wave lithotripsy of a right kidney stone. After satisfactory recovery in the postanesthesia care unit, she was transferred to the ambulatory surgical center for further recovery and discharge home.
About 11 hours after administration of the spinal anesthetic and recovery from the spinal block, the patient complained of not being able to move her left leg. Neurologic examination revealed motor loss and hyperesthesia to touch, vibration, pressure, and temperature from her groin to toes in the left leg only. The remainder of the neurologic examination was normal. A nuclear magnetic resonance scan of the spine revealed no abnormality. Neurologic and psychiatric consultations were sought, and the patient was diagnosed to have a conversion disorder. She responded to psychological intervention and returned to her previous state of health in 2 weeks.
Neurologic deficit following spinal or epidural block should be investigated completely and appropriate consultations sought. Psychiatric disorder may be a rare cause of neurologic deficit after successful regional anesthesia and should be made part of a complete workup.
报道一例成功实施脊髓阻滞术后出现左下肢意外神经功能缺损的病例。
对一名45岁女性，使用25G惠特克针在L3 - L4椎间隙进行脊髓阻滞。在确认有清亮脑脊液流出后，将1.6 mL 0.75%布比卡因注入蛛网膜下腔。患者获得良好的运动和感觉阻滞（平面T4），并顺利接受了右肾结石的体外冲击波碎石术。在麻醉后护理单元满意恢复后，她被转至门诊手术中心进一步恢复并出院回家。
脊髓麻醉给药及脊髓阻滞恢复约11小时后，患者主诉无法移动左腿。神经系统检查显示仅左腿自腹股沟至脚趾存在运动丧失以及对触摸、振动、压力和温度的感觉过敏。其余神经系统检查正常。脊柱核磁共振扫描未发现异常。寻求了神经科和精神科会诊，患者被诊断为转换障碍。她对心理干预有反应，并在2周内恢复到之前的健康状态。
脊髓或硬膜外阻滞后的神经功能缺损应进行全面调查并寻求适当会诊。精神障碍可能是成功实施区域麻醉后神经功能缺损的罕见原因，应成为完整检查的一部分。
