剖宫产术在腰麻-硬膜外联合麻醉过程顺利后出现不明原因的神经功能缺损。
Unexplained neurologic deficit after uneventful combined spinal and epidural anesthesia for cesarean delivery.
作者信息
Paech M J
机构信息
Department of Anaesthesia, King Edward Memorial Hospital for Women, Perth, Western Australia.
出版信息
Reg Anesth. 1997 Sep-Oct;22(5):479-82. doi: 10.1016/s1098-7339(97)80038-7.
BACKGROUND AND OBJECTIVES
Neurologic deficits after spinal and epidural anesthesia are uncommon and have a variety of pathophysiologic mechanisms. Local anesthetic neurotoxicity may occur, although subarachnoid bupivacaine has an unblemished clinical record.
METHODS
A healthy parturient underwent uneventful combined spinal and epidural anesthesia for elective cesarean delivery. Intraspinal drugs administered included hyperbaric bupivacaine 0.5% and fentanyl (subarachnoid) and 2% lidocaine with epinepherine 1:200,000 and meperidine (epidural).
RESULTS
On the third postpartum day the patient reported buttock numbness. An area of hypoesthesia in the distribution of the lower sacral nerves was present, without systemic or other neurologic symptoms and signs. The deficit persisted, and imaging of the lower spinal canal revealed no significant abnormality. Full recovery of sensation occurred after 7 months.
CONCLUSION
Drug-induced neurotoxicity is a possible explanation, although the exact etiology is uncertain.
背景与目的
脊髓和硬膜外麻醉后出现神经功能缺损并不常见，且有多种病理生理机制。尽管蛛网膜下腔布比卡因有着良好的临床记录，但仍可能发生局部麻醉药神经毒性。
方法
一名健康产妇接受择期剖宫产，采用联合脊髓与硬膜外麻醉，过程顺利。鞘内注射的药物包括0.5%重比重布比卡因和芬太尼（蛛网膜下腔），以及含1:200,000肾上腺素的2%利多卡因和哌替啶（硬膜外）。
结果
产后第三天，患者报告臀部麻木。骶神经分布区存在感觉减退区域，无全身或其他神经症状及体征。神经功能缺损持续存在，下椎管影像学检查未发现明显异常。7个月后感觉完全恢复。
结论
尽管确切病因尚不确定，但药物诱导的神经毒性是一种可能的解释。
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