懷孕早期婦女之腰椎神經根病變──超音波導引尾椎硬膜外低濃度高體積利多卡因注射治療

Ultrasound Guided Caudal Epidural High Volume and Low Concentration Lidocaine Injection for Lumbar Radiculopathy in Early Pregnancy

治療懷孕婦女的腰椎神經根病變對臨床醫師而言是一項挑戰。審慎地評估疾病的嚴重程度、懷孕孕程、及胎兒預後對於後續治療計畫相當關鍵。以下是一位第一孕程的婦女，因腰椎神經根病變產生失能性的嚴重疼痛。在排除手術之必要性後，我們在超音波導引下，使用0.2% lidocaine 20mL進行單次尾椎硬膜外注射。除此之外，並利用彩色都卜勒超音波，確認注射液到達病灶位置。雖然懷孕的狀態限制了類固醇的使用，這個病人的疼痛在注射後立刻大幅緩解，並且持續達四個月之久。可能的機轉包括lidocaine的抗發炎效果、發炎物質的稀釋、及疾病的自然病程。總結來說，超音波導引尾椎硬膜外注射，配合大體積的低濃度1idocaine（0.2%），可作為懷孕早期婦女坐骨神經痛的治療選擇。

The management of lumbar radiculopathy during pregnancy can be challenging for physicians. Thorough evaluations regarding disease severity, the stage of pregnancy and fetal outcome are crucial before appropriate treatments. Here, we present a pregnant woman in her first trimester suffering from incapacitating lumbar radiculopathy. After ruling out surgical indication, we performed a single caudal epidural injection with 20 ml of 0.2% lidocaine under ultrasound (US) guidance. Moreover, Doppler ultrasound was used to confirm the injectate up to the pathologic level. Although pregnancy limited the use of steroids, immediate dramatic pain relief was observed in this patient with only lidocaine injection, and the effect lasted for 4 months. The possible mechanisms of action include anti-inflammatory effect of lidocaine, dilution of inflammatory soup, and natural propensity of the radiculopathy towards clinical improvement. In conclusion, the US-guided caudal epidural injection with low concentration (0.2%) but sufficient volume of lidocaine can be a good therapeutic option for treating intractable sciatic pain during early pregnancy.