Carrero E J, Agustí M, Fábregas N, Valldeoriola F, Fernández C
Department of Anaesthesiology, Hospital Clínic i Provincial de Bárceloná, Barcelona University, Spain.
Can J Anaesth. 1998 Sep;45(9):893-7. doi: 10.1007/BF03012226.
To report a rare complication related to epidural analgesia for obstetrics: the association of unilateral trigeminal and facial nerve palsies in a patient with the clinical syndrome of intracranial hypotension.
A 38-yr-old woman was admitted in pre-term labour (at 35 wk gestation). She was receiving 40 mg methadone po daily for opioid addiction. Epidural analgesia for labour was established with 9 ml bupivacaine 0.25%. The patient underwent normal vaginal delivery of a 2500 g female infant. She developed post-dural puncture headache (PDPH) on the third postpartum day which was managed by palliative measures: bed rest (patient's position of choice), increased hydration (water: 3 litres po per day), lysine acetyl salicylate (5.4 g po per day) and caffeine (600 mg po per day). She developed paraesthesiae and numbness of the right side of the face one day after the onset of PDPH and unilateral facial nerve palsy two days later. There was no evidence of dural puncture and no cause was found. Treatment of the nerve palsies with epidural blood patch or epidural dextran 40 was not considered to be indicated. Headache disappeared on the 10th postpartum day and trigeminal palsy regressed. At the time of discharge, on the 17th postpartum day, neurological examination showed minimal facial assimetry. The patient refused further exploration and follow-up.
Post delivery trigeminal and facial nerve palsy in a 38 yr old woman recovered spontaneously with conservative therapy.
报告一种与产科硬膜外镇痛相关的罕见并发症：一名患有颅内低压临床综合征的患者出现单侧三叉神经和面神经麻痹。
一名38岁女性因早产（妊娠35周）入院。她因阿片类药物成瘾每天口服40毫克美沙酮。采用9毫升0.25%布比卡因建立分娩硬膜外镇痛。患者经阴道顺利分娩一名体重2500克的女婴。产后第三天她出现了硬膜穿刺后头痛（PDPH），通过姑息措施进行处理：卧床休息（患者选择的体位）、增加补液量（每天口服3升水）、赖氨酸乙酰水杨酸（每天口服5.4克）和咖啡因（每天口服600毫克）。PDPH发作一天后，她出现右侧面部感觉异常和麻木，两天后出现单侧面神经麻痹。没有硬膜穿刺的证据，也未发现病因。未考虑用硬膜外血补丁或硬膜外右旋糖酐40治疗神经麻痹。产后第10天头痛消失，三叉神经麻痹消退。产后第17天出院时，神经检查显示面部不对称轻微。患者拒绝进一步检查和随访。
一名38岁女性产后三叉神经和面神经麻痹经保守治疗后自发恢复。
