脊髄麻痺患者の下肢痙縮に対するくも膜下フェノールブロック

Intrathecal Block with Phenol and Glycerin in Iotrolan for Treatment of Intractable Spasms in Paraplegic Patients

　抄録：ADLに支障を来した下肢・体幹痙縮に対する痙性除去法として，歩行および自立排尿不能な脊髄麻痺患者7例にくも膜下フェノールブロックを行った．まず脊椎麻酔剤によるテストブロックで効果と膀胱直腸への影響を確認し，後日10％フェノール・グリセリンとイソビスト1：1混合液をくも膜下に片側につき1～4ml注入し，30分側臥位のまま固定した．髄膜刺激症状が1例みられた以外は治療を要する副作用は生じなかった．全例で痙性が消失し，ADL向上，痛み・しびれ感の軽減，自律神経反射の消失などがみられた．一方，問題点としては便秘傾向2例，移動時の軽度尿失禁2例，肛門括約筋弛緩による浣腸使用時の液漏れ1例などがみられた．下肢痙縮は2～24（平均9）カ月で再発し，患者の希望により5例で複数回のブロックを行った．本法は有期限という問題はあるが効果が確実かつ簡便で侵襲が少なく，痙性除去法のひとつとして広く試みられてよい．

　Intractable spasms of the lower extremities and trunk may be a significant source of morbidity in paraplegia patients. We used intrathecal phenol and glycerin in Iotrolan to treat spasticity in seven paraplegic patients. Before using phenol , we performed test blocks with spinal anesthetics in Iotrolan to estimate its efficacy and effect on vesicorectal status. On another day, 1ml to 4ml of a 1：1mixture of 10％ phenol-glycerin and Iotrolan (i.e., a 5％phenol solution) of 10％phenol glycerin and iotrolan was injected into the subarachnoid space under intermittent fluoroscopic monitoring with the patient in the lateral decubitus position. Patients were maintained in the same position for 30minutes, then rolled into the lateral decubitus position on the opposite side, and an additional 1ml to 4ml of the solution was injected. The lower extremities of all patients immediately became flaccid. Two patients experienced a headache after the injection, but it resolved within several hours. There were no serious complications. Spasticity recurred at 2 to 24months (mean；9months) after the initial injection. Repeat injections were performed in fire patients at their own request repetitive injections. Although we were unable to achieve permanent flaccidness, intrathecal block with phenol and glycerin in Iotrolan is very effective and easy to perform, and we consider it to be the treatment of first choice to reduce spasticity in completely paraplegic patients.