- 期刊
Truncal Rigidity as a Result of Epidural Sufentanil - A Case Report
Sufentanil用於硬膜外止痛引起軀體僵直之病例報告
摘要
It is well known that intravenous opioids may cause truncal rigidity. To the best of our knowledge truncal rigidity induced by epidural opioid has never been reported. Recently, we came across an accident of trucal rigidity following epidural sufentanil. The victim was a 65-year-old female who received cholecystectomy, choledochotomy, and cholangiography. For post-operative pain control, an epidural catheter was inserted cephalad at L_(1-2) inter-space with a length of 4 cm of the catheter retained in the epidural space. The epidural catheter was secured and tested for correct placement with 3 ml of 2% lidocaine with 1:200,000 epinephrine prior to induction of general anesthesia. No opioid was ever given in the operative course. When the patient was fully awake and complained of wound pain in the recovery room 50 mg of sufentanil in 10 ml normal saline was given via the epidural catheter after a negative evacuation test. About one minute after the epidural shot, she was found to lose consciousness without any slightest warning sign. Truncal rigidity and locked jaw that followed entailed respiratory arrest and rapid deterioration of oxygenation which evidenced a life-threatening airway emergency. It spite of our efforts we could not manage to ventilate her with ordinary means. It was not until the administration of 80 mg of succinylcholine and oral endotracheal intubation could an adequate ventilation be reestablished. She regained spontaneous breathing 15 min after the episode but for safety's sake she remained intubated for 6 h until the dissipation of analgesia. Another test dose was attempted, which reconfirmed that the epidural catheter was in proper position. She stayed in the recovery room for 24 h and returned to ward in satisfactory condition. The incidence disclosed that epidural sufentanil even with a dose as small as 50 μg could cause truncal rigidity. Thus when epidural sufentanil is applied for post-operative pain control constant vigilance is necessary in order to avoid accident.
並列摘要
眾所周知，嗎啡類藥物用於靜脈注射可引起軀體僵直。若是用於硬膜外止痛，可否引起軀體僵直？據悉並無前例可循。本例為六十五歲女性，於膽道手術麻醉前，置入硬膜外軟管，並加入測試劑（3 ml 2% lidocaine及1:200,000 epinephrine）。麻醉誘導及維持均未使用嗎啡類藥物。術後在恢復室，當病人完全警醒並抱怨疼痛時，我們回抽硬膜外軟管確定沒有血液或腦脊液，經其注射50 μg sufentanil 及10 ml生理食鹽水，予以止痛。一分鐘後病人突然昏厥。並由於軀體僵直，牙關緊閉，血氧濃度下降，形成危及生命之呼吸道急症。直到靜脈注射80 mg succinylcholine後，才能進行氣管內插管，並以呼吸器進行正壓通氣。病人於十五分鐘後自行恢復呼吸。但為防止其他呼吸併發症，仍維持氣管內插管，直到六小時後止痛效果消失，才予拔管。我們又再次以3 ml 2% lidocaine及1:200,000 epinephrine測試，確定止痛軟管的位置，正確無誤。病人於恢復室觀察二十四小時後，平安回到病房。結論：認為硬膜外注射之sufentanil，即使只有50μg，也可能造成軀體僵直。警醒的醫護人員及適當的監視器，是保障病人安全的不二法門。