Total Spinal Block and Cervical Epidural Block for whiplash Syndrone and Reflex Sympathetic Dystrophy

Park, Wook; Ok, See Young; Song, Hoo Bin

Abstract

For the relief of pain in 3 cases of whiplash syndromes (case I, II and IV) and in one of reflex sympathetic dystrophy (case III), we have carried out six intentional. total spinal blocks (TSB) which attempted two times in case I, three in case II and one in case III whose various symptoma were chronically unresponsive to the usual conservative treatments, and a time of cervical epidural and right suprascapular nerve block in case IV whose acute symptom lasted 4 days following the cervical injury (see tables from 1 to 9). During the TSB, we have observed clinically the sequential changes of respiration, lid and pupil reflexes, body motion and consciousness. And checked the blood pressure, pulse rate and arterial Pco2. The effectiveness of those blocks has been assessed by using the Visual Analog Scale which is designed to measure the patients subjective intensity of pain and also we have found out the sequelae following those blocks. The methods of the blocks were as the following: l. Under the N.P.O. for 8-10 hours, the preparations of immediate cardiopulmonary resuscitation and premedication with atropine 0.5mg at thirty minutes before the TSB, it was performed by injecting the mixture of 2% mepivacaine 10 or 15ml and normal saline 10 or 5ml through No. 23 G. spinal needle into the subarachnoid space of C7-T1 interspinous region with fully flexed neck on the lateral posture. Immediately after the injection of the local anesthetic in the lateral position, the patienth were hasten to change Trendelenburgh position in order to act the drugs cephalad and to make easy controlled respiration with oxygen. 2. The cervieal epidural block was done by injecting the mixture of 0.5% bupivacaine 4ml, normal saline 4ml and triamcinolone 15mg through No. 18 G. Tuohy needle into the epiduralspace on the same region and posture as the above without premedication, The suprascapular nerve block was done by injecting of 0. 5% bupivacaine 3ml only into the right suprascapular fossa on the sitting posture. The results were as the following: 1. The cessation of respiration was seen within 5 minutes following the subarachnoidal injection of the above 20ml mixture in 2 to 3 minutes and then soon the consciousness began to disappear. The loss of lid and pupil reflexes noted between 5 to 10 minutes and the size of the dilated pupils was equal between 5 to 20 minutes, but the pupil of the dependent side on the lateral pcsition was dilated 1 to 3 minutes earlier than that of the independent. The patients had never responded to any stimulations during the TSB except their heart funtion. 2. The recovery of the TSB was as the following, firstly the ankle and lower limb of the independent side began to move slightly with in 34 to 75 minutes after the injection and then that of the dependent. Secondly the neck and upper limb moved 6 to 15 rninutes later than the lower limb. Thirdly the self respiration began to appear between 40 to 80 minutes from the block. The lid and pupil reacted to touch and light respectively between 40 to 80 minutes but the pupil of the indepedent side responded earlier than that of the dependent. Lastly the consciousness recovered completely between 80 to 125 minutes from the block. 3. In the cardiopulmonary function during the TSB, the blood pressure were stable except the 210/l30 torr at the 2nd block of case I. There were bradycardias between 65 to 85 minutes in case I and II but no arrythmia on the EKG. The level of the arterial Pco2 was maintained to 43-45 torr during the TSB. 4. The effectiveness of the above blocks was no pain (0%) in case IV, and light (10 20%) in case I and II but no improvemeat in case III. 5, The right arm weakness has been complicated as to be injected accidently the "COLD" local anesthetic at the 2nd block of case I.

Total Spinal Block and Cervical Epidural Block for whiplash Syndrone and Reflex Sympathetic Dystrophy

Abstract

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