Kaetsu H, Ikegaki J, Chigusa S, Miyakuchi O, Kaneda N
Department of Anesthesia, Hyogo Medical Center for Adult, Akashi.
Masui. 1996 Oct;45(10):1285-8.
A 57-year-old man received gastrectomy under general anesthesia combined with epidural anesthesia. He showed no signs of dural puncture and catheter migration into the subarachnoid space. Cardiovascular status was stable with epidural injection of lidocaine, morphine during the operation. Although epidural morphine and buprenorphine infusions were continued for 1 to 6 postoperative days, respiratory depression and other side effects were not observed. However, severe headache in the upright position occurred after stopping these infusions and the removal of the catheter on the 7th postoperative day. The headache was thought to be caused by unintentional dural puncture. PDPH persisted over a period of 30 days and was treated with an epidural blood patch and stellate ganglion blocks since the other conservative therapy had been ineffective. We consider that administration of continuous epidural opioids for postoperative analgesia helped to prevent PDPH until the 7th postoperative day. We also conclude that prolonged PDPH after using a thick needle like a Touhy needle should be treated by an epidural blood patch.
一名57岁男性在全身麻醉联合硬膜外麻醉下行胃切除术。术中未出现硬膜穿刺及导管移入蛛网膜下腔的迹象。手术过程中硬膜注射利多卡因、吗啡时心血管状况稳定。尽管术后1至6天持续硬膜输注吗啡和丁丙诺啡，但未观察到呼吸抑制及其他副作用。然而，术后第7天停止这些输注并拔除导管后，患者出现了直立位严重头痛。考虑头痛系无意硬膜穿刺所致。因其他保守治疗无效，体位性头痛持续30天，后采用硬膜外血补丁及星状神经节阻滞治疗。我们认为术后持续硬膜给予阿片类药物镇痛有助于预防术后第7天前的体位性头痛。我们还得出结论，使用如Tuohy针这样的粗针后出现的长时间体位性头痛应采用硬膜外血补丁治疗。
