Gentili M, Aveline C, Bonnet F
Département d'anesthésie-réanimation 2, CMC Saint-Vincent, Paris, France.
Ann Fr Anesth Reanim. 1998;17(7):740-2. doi: 10.1016/s0750-7658(98)80112-3.
We report a case of total spinal anaesthesia which occurred after a lumbar plexus block using a posterior approach. After total hip arthroplasty under general anaesthesia, a lumbar plexus block was performed according to Winnie's landmarks at the L4 interspace using a nerve stimulator. Aspiration test for blood and spinal fluid were both negative, as well as a test dose of 3 mL lidocaine 2%-bupivacaine 0.5%. One minute after the injection of 27 mL of the same mixture, a complete anaesthetic block occurred with hypotension and loss of consciousness requiring intubation and controlled ventilation during 3h30, without sequelae. Lumbar plexus block using a posterior approach must be performed cautiously and a slow and fractionated injection of the full dose is recommended.
我们报告了一例采用后路法进行腰丛神经阻滞术后发生全脊髓麻醉的病例。在全身麻醉下行全髋关节置换术后，使用神经刺激仪，根据温妮（Winnie）定位法于L4椎间隙进行腰丛神经阻滞。血液及脑脊液抽吸试验均为阴性，给予3 mL 2%利多卡因-0.5%布比卡因试验剂量后也为阴性。注射27 mL相同混合液1分钟后，出现完全性麻醉阻滞，伴有低血压和意识丧失，在3小时30分钟内需要进行气管插管和控制通气，且无后遗症。采用后路法进行腰丛神经阻滞时必须谨慎操作，建议缓慢分次注射全量药物。
