Thông báo một trường hợp ức chế cảm giác và vận động hai chi dưới kéo dài sau gây tê tủy sống được điều trị thành công bằng nhũ dịch lipid 20%

Abstract

Prolonged motor and sensory block in lower extremities post spinal anesthesia is a rare complication. Recently, we have performed a spinal anesthesia using the mixture of 10mg bupivacain 0.5% heavy and 20mcg fentanyl for a 27-year-old woman, ASA I who were indicated a L4-L5 spinal fixed surgery at the 108 Military Central Hospital. The patient has been suffering a severe complication of paralysis and lost sensation exhibited from bellow T10 even after 7 hours. The diagnostic result of spinal MRI has ruled out substantional injuries. Based on the clinical manifestations and MRI result, we considered that, in this case, the cause of anesthesia paralysis was prolonged following spinal anesthesia with bupivacaine 0.5%. The patient was treated by lipid emulsion 20% with bolus dose of 1.5ml/kg for 3 minutes, followed by 400ml for 2 hours. Immediately after the first dose of the bolus, the motor block was recovered from level 3 to level 1 according to Bromage scale. The sensory block was recovered from T10 to T12 and the patient was recovered fully from sensory and motor block after 2 hours. Lipid emulsion 20% has the effectiveness of recovered neuromuscular activity in case of prolonged motor and sensory block following spinal anesthesia with bupivacaine