腕神経叢ブロック後に四肢不全麻痺を呈し偶発的硬膜外麻酔になったと考えられた2症例

Two Cases of Quadriparesis due to Epidural Anesthesia after Continuous Interscalene Brachial Plexus Block

要旨

　超音波ガイド下斜角筋間法による持続腕神経叢ブロック後に四肢不全麻痺を呈した2症例を経験した。麻痺は病棟帰室後に出現し，持続投与中止後数時間で消失した。局所麻酔薬が硬膜外腔に浸潤することで硬膜外麻酔に至ったと考えられる。腕神経叢ブロック後は呼吸状態に加え，四肢神経症状の出現に留意すべきである。

　We encountered two cases of quadriplegia after continuous brachial plexus block. For both patients, a continuous brachial plexus block was performed after shoulder surgery with the use of an ultrasound-guided interscalene muscle technique. Both patients developed quadriplegia after returning to the ward, and the symptoms disappeared within a few hours after the block was discontinued. Based on the patients’ clinical courses, it is highly probable that epidural anesthesia was incidentally caused by infiltration of the local anesthetic into the epidural space. After a brachial plexus block is administered, we should pay attention to other neurological symptoms in addition to transverse nerve palsy.