硬脊膜外疼痛控制造成對腎臟移植相關股神經病變的誤診

Epidural Analgesia Masked the Diagnosis of Femoral Neuropathy Following Renal Transplantation

腎臟移植所造成的股神經病變，其臨床表現可能和硬脊膜外導管置入所造成的神經性病變有所相似。麻醉醫師在為腎臟移植的病人進行硬脊膜外疼痛控制時應注意到這個問題。我們報告一例52歲男性病患，為了進行腎臟移植手術中的輔助性區域麻醉和術後的自動控制式硬脊膜外止痛，他在手術前接受了由胸椎第11至12節間隙置入的硬脊膜外導管。這位病人，在手術後抱怨下肢有感覺異常的情形，並且逐漸發生肌肉無力的問題。一開始，我們認為硬脊膜外的血腫所造成的壓迫性神經線病變並無法被排除。我們馬上安排更進一步的檢查，包括胸腰部脊椎的電腦斷層、腹部超音波、以及神經生理學的肌電圖和神經傳導速率檢查。根據這些檢查的結果，最後的診斷是因為手街過程造成的股神經病變。我們相信，本篇是首度針對此種可能發生的臨床困擾所做的報告。在進行腎臟移植的病人身上採用術後硬脊膜外止痛，可能會混淆對腎臟移植所造成的股神經病變的診斷。藉由影像學和電生理的檢查，我們可以得到精確的診斷並與予適當的處置。

Kidney transplantation related femoral neuropathy can mimic epidural catheter related radiculopathy in clinical presentation. Anesthesiologists should keep this possibility in mind when performing epidural anesthesia or analgesia for kidney transplantation. We present a 52-year-old male who after undergoing cadaveric kidney transplantation under general anesthesia in combination with epidural analgesia made possible by catheterization via T11-12 interspace for reinforcement of anesthesia and for postoperative patient-controlled epidural analgesia (PCEA) sustained sensory disturbance and muscle weakness of the lower limbs. These symptoms did not improve after discontinuation of the PCEA. Epidural hematoma with secondary radiculopathy was contemplated initially. Serial examinations including thoracic-lumbar CT scan, abdominal sonography, electromyogram and nerve conduction study were thus performed. The final diagnosis turned out to be surgical procedure related femoral neuropathy. We believe this is the first instance ever reported about the dilemma in making a predicative diagnosis from two conditions near akin in kidney transplantation. Accurate diagnosis made through serial image and electrophysiologic studies are essential to appropriate management.