硬脊膜穿剌後造成臂痛及上背痛之病例報告

Post-dural Puncture Arm and Upper Back Pain——A Report of Two Cases

典型的硬脊膜穿刺後頭痛症狀為姿態性的額部、額顧部或枕部頭痛，會因活動而加劇，因平躺而改善。其伴隨的症狀通常包含噁心、嘔吐與頸部僵硬症。而有數種少見的硬脊膜穿刺後的症狀曾由文獻中提出，例如硬脊膜穿刺後上背痛、臂痛、胸廓痛及造成腸道與膀胱的功能障礙。我們提出兩個接受脊椎麻醉後產生硬脊膜穿刺後頭痛症狀合併手臂麻痛及上背痛的病例報告實屬罕見，且經硬脊膜外血液填補後症狀完全消除。提出這兩個硬脊膜穿刺後非典型症狀的案例，可提供醫護人員對病人術後照護的警覺性。我們可以發現在排除其他可能的病因後，硬脊膜外企液填補術是可以當做治療的選擇之一。

The typical postdural puncture headache manifests as postural frontal, frontotemporal, or occipital headache, which is worsened by ambulation, and improved by decubitus. Accompanying symptoms are nausea, vomiting, and neck stiffness. Various rare presentations after dural puncture, such as upper back pain, arm pain, thoracic pain, bowel and bladder dysfunction have been sparsely reported. We report two cases who sustained arm and upper back pain after spinal anesthesia, and epidural blood patch gave them a complete relief of the symptoms.