Neurologic Complication Due to Crystallization After Drug Interaction Between Alkalized Lidocaine and Ropivacaine: A Case Report and in vitro Study.
Neurologic Complication Due to Crystallization After Drug Interaction Between Alkalized Lidocaine and Ropivacaine: A Case Report and in vitro Study.
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碱化利多卡因和罗哌卡因药物相互作用后因结晶引起的神经系统并发症：病例报告和体外研究
DOI：
10.3389/fmed.2022.919911
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发表时间：
2022
影响因子：
3.9
通讯作者：
中科院分区：
文献类型：
--
作者：
对于接受硬膜外分娩镇痛后转急诊剖宫产的孕妇，如何快速有效地实施手术麻醉仍存在争议。碱化利多卡因通常用于快速起效;然而，麻醉剂的结晶可能导致严重的神经系统症状。我们报告一位孕妇接受紧急剖腹产手术，镇痛效果满意，但下肢出现严重无力及感觉异常。通过症状体征和磁共振成像排除腰椎间盘突出、产神经损伤和麻醉技术原因后，药物相关性损伤成为最可能的原因。我们的体外试验证实了额外的麻醉浓缩罗哌卡因（0.5-1%）与预处理的碱化利多卡因的明显沉淀。经营养神经治疗后，产妇在第4天时虚弱症状迅速缓解，但麻木症状延迟恢复，持续4周。迄今为止，这是第一例报告神经系统并发症可能是由于药物结晶剖宫产。我们的研究证实了碱化利多卡因起效快，其安全性优于预处理的常规分娩剂量罗哌卡因（0.09%）。然而，不建议使用额外的麻醉浓缩罗哌卡因（0.5-1%）来维持麻醉和镇痛水平。
For pregnant women transferred to emergency cesarean section after receiving epidural labor analgesia, there is still a debate over the effective and safe means of rapidly delivering surgical anesthesia. Alkalized lidocaine is often adopted for fast onset time; however, crystallization of the anesthetic may cause severe neurologic symptoms. We report a case of a pregnant woman who underwent emergency cesarean section with satisfied analgesia but experienced severe weakness and paranaesthesia in the lower limb. After excluding lumbar disc herniation, obstetric nerve injury, and anesthesia technique causes by symptoms signs and magnetic resonance imaging, drug-related injury became the most likely cause. Our in vitro testing confirmed the obvious precipitation of additional anesthetic-concentrated ropivacaine (0.5–1%) with pretreated alkalized lidocaine. With trophic neurotherapy, the parturient attained prompt relief of weakness by day four, but delayed recovery of numbness, which lasted for 4 weeks. To date, this is the first case reporting neurologic complication possibly due to drug crystallization in cesarean section. Our study confirmed the rapid onset of alkalized lidocaine and its safety to pretreated routine labor dose of ropivacaine (0.09%). However, additional anesthetic-concentrated ropivacaine (0.5–1%) to maintain the anesthesia and analgesia level is not suggested.
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影响因子：
2.8
作者：
Tuleu, C.;Allam, J.;Yentis, S. M.
通讯作者：
Yentis, S. M.
影响因子：
3
作者：
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Hsu, Wen-Yen
影响因子：
1.6
作者：
Watkins, Trevor William;Dupre, Simon;Coucher, John Richard
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Coucher, John Richard
影响因子：
5.7
作者：
Sharawi, Nadir;Bansal, Prannal;Mhyre, Jill M.
通讯作者：
Mhyre, Jill M.
影响因子：
3.6
作者：
Milner, QJW;Guard, BC;Allen, JG
通讯作者：
Allen, JG