Goldschneider K R, Brandom B W
Department of Anesthesiology, Children's Hospital of Pittsburgh, Pennsylvania 15213-2583, USA.
Reg Anesth Pain Med. 1999 Nov-Dec;24(6):553-6. doi: 10.1016/s1098-7339(99)90048-2.
The performance of caudal injection (CI) has become a routine part of pediatric anesthesia. The intraoperative and immediate postoperative complications of CIs have been reported extensively. Although the long-term consequences of CI are unknown, they may include the development of epidermoid tumors in the spinal canal. Such tumors have been attributed to tissue coring (the process by which pieces of tissue are removed by a needle as it passes through the tissue) and the subdural deposition of such tissue.
In this study, we examine the internal needle of 20-gauge i.v. cannulae from 50 CIs for evidence of tissue coring.
We found a total coring incidence of 54% (95% confidence interval = 40-68%). Epidermal tissue was present in 33% of the positive samples. Fat was present in 67% of the positive samples and bloody material in 26%. This study provides an estimate (with a 95% confidence interval) of the rate of coring during CI performed with hollow point needles.
These findings suggest that technical modifications may improve patient safety. The results also have implications for long-term follow-up of caudal anesthetics. Techniques for reducing the incidence of tissue coring during the performance of CI are discussed.
骶管注射（CI）操作已成为小儿麻醉的常规组成部分。CI术中及术后即刻并发症已有广泛报道。尽管CI的长期后果尚不清楚，但可能包括椎管内表皮样肿瘤的发生。此类肿瘤被认为与组织钻取（即针穿过组织时组织块被针移除的过程）以及此类组织的硬膜下沉积有关。
在本研究中，我们检查了来自50例CI操作的20号静脉套管针的内针，以寻找组织钻取的证据。
我们发现总的钻取发生率为54%（95%置信区间 = 40 - 68%）。33%的阳性样本中存在表皮组织。67%的阳性样本中存在脂肪，26%的阳性样本中存在血性物质。本研究提供了使用空心针进行CI操作时钻取率的估计值（及其95%置信区间）。
这些发现表明技术改进可能会提高患者安全性。这些结果对骶管麻醉的长期随访也有意义。文中讨论了在CI操作过程中降低组织钻取发生率的技术。
