椎間板ヘルニアが圧排した脊髄後索への硬膜外カテーテルによる圧迫が原因と考えられた深部知覚異常を呈した1症例  [in Japanese] A case of deep paresthesia caused by insertion of an epidural catheter  [in Japanese]

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Author(s)

    • 木村 哲朗 KIMURA Tetsuro
    • 浜松医科大学附属病院手術部 Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine
    • 五十嵐 寛 IGARASHI Hiroshi
    • 浜松医科大学臨床医学教育講座 Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine
    • 佐藤 重仁 SATO Shigehito
    • 浜松医科大学附属病院麻酔科・蘇生科(痛みの治療科) Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine

Abstract

硬膜外カテーテル挿入後に深部知覚異常を呈し,診断に難渋した症例を経験した.症例は78歳の男性で,右上肢帯状疱疹後神経痛に対しC6/7より硬膜外カテーテルを挿入した.局所麻酔薬の持続投与を開始したところ,痛みは完全に消失した(皮疹部:右C6領域).1時間の安静後,左足に違和感を訴えたが知覚·運動覚ともに正常であったため経過を観察した.さらに3時間後に起立困難となったため,持続投与を中止し造影CTを撮影した.CTでは異常所見はなかったが,深部知覚異常を認め脊髄後索障害が疑われたため,カテーテルを抜去し頸部MRIを撮影した.MRIで右C7神経根を圧迫する椎間板ヘルニアが確認された.カテーテルの抜去によりただちに左下肢の症状は軽減し,1週間後にはほぼ消失した.深部知覚異常は,ヘルニアにより後側方にシフトした脊髄後索を硬膜外カテーテルが圧迫していたために生じたと考えられた.

We report our experience in making a difficult diagnosis for a patient who developed deep paresthesia after insertion of an epidural catheter. The case was a 78-year-old male patient who received treatment for herpes zoster in the right-upper extremity. When an epidural catheter was inserted from C6/7 to begin continuous administration, the pain was completely eliminated. After 1 hour of rest, the patient complained of discomfort in his left-lower extremity. Since he continued to have difficulty in standing up, the continuous administration was discontinued. The catheter was removed, and cervical MRI was performed. As a result, intervertebral disc herniation compressing the right C7 nerve root was confirmed. Immediately after removal of the catheter, the symptom was improved. It was considered that deep paresthesia was caused when the epidural catheter compressed the dorsal column of the spinal cord, which was shifted in a posterolateral direction by cervical disc herniation compressing the nerve root similar to that of the herpes zoster.

Journal

  • Journal of Japan Society of Pain Clinicians

    Journal of Japan Society of Pain Clinicians 20(1), 44-47, 2013-02-25

    Japan Society of Pain Clinicians

References:  8

Codes

  • NII Article ID (NAID)
    10031155681
  • NII NACSIS-CAT ID (NCID)
    AN10440947
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    13404903
  • NDL Article ID
    024325096
  • NDL Call No.
    Z19-B321
  • Data Source
    CJP  NDL  J-STAGE 
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