医学文章阅读——Case Reports of Transient Radicular Irritation After Spinal Anesthesia with Hyperbaric 4% Mepivacaine
Case 1: A 28-year-old, 65- kg woman was scheduled for cervical dilatation and curettage for fetal demise in the eighth week of pregnancy. After skin preparation with povidone iodine 10%, an atrautmatic spinal anesthetic was performed with a 27 gauge Whitacre needle (midlinc approach, sitting, L3-4). After free flow of cerebrospinal fluid was observed, 70 mg of 4% mepivacaine in 9.5% glucose was injected. No pain, paresthesia, or bleeding was noted. The patient was placed in the lithotomy position for the procedure, which was uneventful and lasted 15 min. Adequate anesthesia was achieved with an upper sensory level of T7. Three hours after the anesthetic, the patient complained of an aching pain radiating from the buttocks to the posterior thighs. The pain was described as moderately severe, persisted for 12 h, and required treatment with diclofenac. No other neurological symptoms or signs were noted.
Case 2: A 51 year old, 61 kg woman was scheduled for cervical dilatation and diagnostic curettage for postmenopausal bleeding. Her medical history included a hiatal hernia and occasional palpitations. Spinal anesthesiat was performed at the L3-4 interspace with 70 mg 4% mepivacaine in glucose 9.5% using a 27-gauge Whitacre needle. An upper sensory level of T9 was achieved, and the procedure proceeded uneventfully in the lithotomy position. Four hours postoperatively, the patient complained of severe aching pains in the lower back radiating along the posterior aspect of both thighs and calves. An anesthesiologist was summoned because the patient could not lie or sit comfortably. No neurological abrormalities were found on examination. The pain improved after medication with acetaminophen, and the patient was pain free after 24h.
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