Kahn L
Department of Anesthesia, St. Joseph's Hospital, Hamilton, Ontario, Canada.
Can J Anaesth. 1997 Mar;44(3):313-6. doi: 10.1007/BF03015371.
The purpose of this report is to emphasise the role of the Acute Pain Service in managing local anaesthetic epidural infusions for postoperative pain management, the importance of vigilant monitoring, and to offer some guidelines to using local anaesthetic epidural infusions.
A 34-yr-old man with long-standing insulin dependent diabetes mellitus underwent a total proctocolectomy for inflammatory bowel disease. A T9-10 epidural catheter was placed prior to induction of general anaesthesia. Postoperatively, a continuous epidural infusion of fentanyl/bupivacaine was used for postoperative pain management. Total lithotomy time was four hours. On day four he was noted to have complete right sided femoral and left sided lateral femoral cutaneous nerve of thigh neuropathies. A computerised tomography scan and a magnetic resonance imaging excluded a central lesion. Electromyelography confirmed peripheral nerve injuries.
This patient's neurological deficits were not due to the epidural analgesia. However, epidural infusion of local anaesthetic caused a delay in recognising a potential neurological complication. When using local anaesthetic epidural infusions, it is important to exclude other causes of motor block before attributing it to the local anaesthetic.
本报告旨在强调急性疼痛服务在管理术后疼痛的局部麻醉硬膜外输注中的作用、警惕监测的重要性，并提供一些使用局部麻醉硬膜外输注的指南。
一名34岁长期依赖胰岛素的糖尿病男性因炎症性肠病接受了全直肠结肠切除术。在全身麻醉诱导前放置了T9-10硬膜外导管。术后，使用芬太尼/布比卡因持续硬膜外输注进行术后疼痛管理。总截石位时间为4小时。在第四天，发现他有右侧完全性股神经和左侧股外侧皮神经病变。计算机断层扫描和磁共振成像排除了中枢病变。肌电图证实为周围神经损伤。
该患者的神经功能缺损并非由硬膜外镇痛引起。然而，局部麻醉药的硬膜外输注导致了对潜在神经并发症的识别延迟。在将运动阻滞归因于局部麻醉药之前，排除其他运动阻滞原因很重要。
