Tsutsui T, Muranaka K, Setoyama K
Department of Anesthesia, Saga National Hospital.
Masui. 2000 Sep;49(9):970-5.
We analyzed retrospectively the technical and clinical consequences of combined spinal-epidural anesthesia by needle-through-needle approach over the last two years. A Tuohy-type 18-gauge epidural needle (Perican; B. Braun Co.) and long pencil-pointed 27-gauge spinal needle (Whitacre; Becton-Dikinson Co.) were selected. Spinal anesthesia was administered with 0.5% tetracaine. A total of 485 anesthesia cases included 144 cases for lower abdominal, 193 cases for gynecological and 148 cases for orthopedic surgeries. The successful subarachnoid puncture with only one attempt was recorded in 89% of abdominal, 71% of gynecological and 72% of orthopedic cases. On the other hand, in three (0.6%) cases even with several attempts, the puncture was not possible. Inadvertent dural puncture and subarachnoid catheterization occurred in six (1.2%) and four (0.6%) cases, respectively. Inadequate spinal anesthesia was supplemented with epidural anesthesia in 13% of abdominal, 21% of gynecological and 7% of orthopedic cases. No serious complication occurred. We conclude that this needle-through-needle approach facilitates subarachnoid puncture with an ultra-fine spinal needle and subsequent epidural catheterization serves for supplemental and post-operative analgesia unless inappropriate subarachnoid indwelling occurs.
我们回顾性分析了过去两年采用针内针法进行腰麻-硬膜外联合麻醉的技术及临床效果。选用了18G Tuohy型硬膜外穿刺针（Perican；贝朗公司）和27G长笔尖式腰穿针（Whitacre；BD公司）。腰麻采用0.5%丁卡因。485例麻醉病例中，包括下腹部手术144例、妇科手术193例和骨科手术148例。腹部手术89%、妇科手术71%和骨科手术72%的病例一次腰穿成功。另一方面，有3例（0.6%）即使多次尝试仍无法穿刺成功。意外硬膜穿破和蛛网膜下腔置管分别发生在6例（1.2%）和4例（0.6%）患者中。腹部手术13%、妇科手术21%和骨科手术7%的病例在腰麻效果不佳时加用硬膜外麻醉。未发生严重并发症。我们得出结论，这种针内针法便于使用超细腰穿针进行蛛网膜下腔穿刺，后续硬膜外置管可用于补充麻醉及术后镇痛，除非发生不恰当的蛛网膜下腔留置。
