The Korean Journal of Pain

  • 제21권2호
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  • Pages.159-163
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  • 2008
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  • 2005-9159(pISSN)
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  • 2093-0569(eISSN)
대한통증학회 (The Korean Pain Society)
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산모에서 발생한 경막외 블록 후 하지 마비 -증례보고-

A Case of Paraplegia Associated with Epidural Anesthesia -A case report-

  • 김현혜 (울산대학교 의과대학 서울아산병원 마취통증의학교실) ;
  • 김두환 (울산대학교 의과대학 서울아산병원 마취통증의학교실) ;
  • 김성훈 (울산대학교 의과대학 서울아산병원 마취통증의학교실) ;
  • 임정길 (울산대학교 의과대학 서울아산병원 마취통증의학교실) ;
  • 이청 (을지대학교 의과대학 마취통증의학교실) ;
  • 신진우 (울산대학교 의과대학 서울아산병원 마취통증의학교실)
  • Kim, Hyun Hea (Department of Anesthesiology and Pain Management, Asan Medical Center, University of Ulsan College) ;
  • Kim, Doo Hwan (Department of Anesthesiology and Pain Management, Asan Medical Center, University of Ulsan College) ;
  • Kim, Sung Hoon (Department of Anesthesiology and Pain Management, Asan Medical Center, University of Ulsan College) ;
  • Leem, Jeong Gill (Department of Anesthesiology and Pain Management, Asan Medical Center, University of Ulsan College) ;
  • Lee, Cheong (Eulji University Hospital, Eulji University College of Medicine) ;
  • Shin, Jin Woo (Department of Anesthesiology and Pain Management, Asan Medical Center, University of Ulsan College)
  • 투고 : 2008.06.24
  • 심사 : 2008.07.30
  • 발행 : 2008.08.30
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초록

Paraplegia is a relatively rare complication of epidural anesthesia. Several possible factors may contribute to the development of paraplegia including arachnoiditis, trauma and ischemia. We experienced a case where paraplegia had developed after epidural anesthesia for cesarean section. So we present the case and consider the possible etiologies. A 30-year-old previously healthy woman was referred to our hospital for postpartum motor weakness of the lower limbs. Six days prior, the patient was admitted at a local obstetric clinic for delivery at 39 weeks gestation. The patient underwent a Cesarean section under epidural anesthesia induced with 20 ml 2% lidocaine and 5 ml 0.5% bupivacaine. In the early morning of the day following the Cesarean section, a motor and sensory deficit in both lower extremities was noted. A lumbar MRI showed diffuse enhancement along the cauda equina and spinal cord surface in the lower lumbar spine, suggesting diffuse arachnoiditis.

키워드

참고문헌

  1. Jang H, Kim JH, Gang HS: Spinal arachnoiditis after continuous epidural block. Korean J Pain 1997; 10: 301-3
  2. Kararmaz A, Turhanoglu A, Arslan H, Kaya S, Turhanoglu S: Paraplegia associated with combined spinal-epidural anaesthesia caused by preoperatively unrecognized spinal vertebral metastasis. Acta Anaesthesiol Scand 2002; 46: 1165-7 https://doi.org/10.1034/j.1399-6576.2002.460919.x
  3. Ploteau S, de Kersaint-Gilly A, Boog G: Medullar adhesive arachnoiditis: a late complication after obstetrical epiduralanalgesia. Gynecol Obstet Fertil 2004; 32: 961-4 https://doi.org/10.1016/j.gyobfe.2004.08.020
  4. Rice I, Wee MY, Thomson K: Obstetric epidurals and chronic adhesive arachnoiditis. Br J Anaesth 2004; 92: 109- 20 https://doi.org/10.1093/bja/aeh009
  5. Aldrete JA: Chronic adhesive arachnoiditis. Br J Anaesth 2004; 93: 301 https://doi.org/10.1093/bja/aeh591
  6. Tseng SH, Lin SM: Surgical treatment of thoracic arachnoiditis with multiple subarachnoid cysts caused by epidural anesthesia. Clin Neurol Neurosurg 1997; 99: 256-8 https://doi.org/10.1016/S0303-8467(97)00086-3
  7. Aldrete JA: Neurologic deficits and arachnoiditis following neuroaxial anesthesia. Acta Anaesthesiol Scand 2003; 47: 3-12 https://doi.org/10.1034/j.1399-6576.2003.470102.x
  8. Aldrete JA, Brown TL: Intrathecal hematoma and arachnoiditis after prophylactic blood patch through a catheter. Anesth Analg 1997; 84: 233-4 https://doi.org/10.1213/00000539-199701000-00059
  9. Reisner LS, Hochman BN, Plumer MH: Persistent neurologic deficit and adhesive arachnoiditis following intrathecal 2-chloroprocaine injection. Anesth Analg 1980; 59: 452-4
  10. Bennett G, Serafini M, Burchiel K, Buchser E, Classen A, Deer T, et al: Evidence-based review of the literature on intrathecal delivery of pain medication. J Pain Symptom Manage 2000; 20: S12-36 https://doi.org/10.1016/S0885-3924(00)00148-2
  11. Muguruma T, Sakura S, Saito Y: Epidural lidocaine induces dose-dependent neurologic injury in rats. Anesth Analg 2006; 103: 876-81 https://doi.org/10.1213/01.ane.0000237287.53957.18
  12. Sklar EM, Quencer RM, Green BA, Montalvo BM, Post MJ: Complications of epidural anesthesia: MR appearance of abnormalities. Radiology 1991; 181: 549-54 https://doi.org/10.1148/radiology.181.2.1924803
  13. Haisa T, Todo T, Mitsui I, Kondo T: Lumbar adhesive arachnoiditis following attempted epidural anesthesia--case report. Neurol Med Chir (Tokyo) 1995; 35: 107-9 https://doi.org/10.2176/nmc.35.107
  14. Malinovsky JM, Pinaud M: Neurotoxicity of intrathecally administrated agents. Ann Fr Anesth Reanim 1996; 15: 647-58 https://doi.org/10.1016/0750-7658(96)82129-0

피인용 문헌

  1. Severe adhesive arachnoiditis resulting in progressive paraplegia following obstetric spinal anaesthesia: a case report and review vol.67, pp.12, 2012, https://doi.org/10.1111/anae.12017
  2. Unexplained episode of sensory-motor deficit following lumbar epidural analgesia vol.32, pp.1, 2019, https://doi.org/10.3344/kjp.2019.32.1.53
  3. Adhesive Arachnoiditis following Inadvertent Epidural Injection of 2% Chlorhexidine in 70% Alcohol-Partial Recovery over the Ensuing Eight Years vol.46, pp.6, 2008, https://doi.org/10.1177/0310057x1804600606