Grau T, Leipold R W, Fatehi S, Martin E, Motsch J
University of Heidelberg, Department of Anaesthesiology, Heidelberg, Germany.
Eur J Anaesthesiol. 2004 Jan;21(1):25-31. doi: 10.1017/s026502150400105x.
The quality of combined spinal-epidural anaesthesia mainly depends on accurate identification of the epidural space. The real-time ultrasound control of the procedure for puncture was therefore evaluated.
Thirty parturients scheduled for Caesarean section were randomized to three equal groups. Ten control patients received conventional combined spinal-epidural anaesthesia. Ten of the remaining patients received ultrasonic scans by an offline scan technique, and 10 received online imaging of the lumbar region during epidural puncture. The epidural space was identified and needle advancement was surveyed through the interspinal and flaval ligaments. The number of attempts to advance the needle to achieve a successful puncture was measured and compared, as well as the number of vertebral interspaces punctured before successful entry into the epidural space.
There was no difference between patient characteristics in the three groups. The visualization of the epidural structures and of the needle manipulations was very effective. In the ultrasound group, the reduction in the number of attempts at puncture was significant (P < 0.036). The number of interspaces necessary for puncture was reduced (P < 0.036) in the ultrasound online group compared with controls. The number of spinal needle manipulations was significantly reduced (P < 0.036).
Real-time ultrasonic scanning of the lumbar spine is an easy procedure. It provides an accurate reading of the location of the needle tip and facilitates the performance of combined spinal-epidural anaesthesia.
腰麻-硬膜外联合麻醉的质量主要取决于硬膜外间隙的准确识别。因此，对穿刺过程的实时超声引导进行了评估。
30例计划行剖宫产的产妇被随机分为三组，每组10例。10例对照组患者接受传统的腰麻-硬膜外联合麻醉。其余20例患者中，10例采用离线扫描技术进行超声扫描，10例在硬膜外穿刺时接受腰部区域的在线成像。通过棘间韧带和黄韧带识别硬膜外间隙，并观察穿刺针的推进情况。测量并比较将穿刺针推进至成功穿刺所需的尝试次数，以及成功进入硬膜外间隙前穿刺的椎间隙数量。
三组患者的特征无差异。硬膜外结构和穿刺针操作的可视化效果非常好。在超声组中，穿刺尝试次数的减少具有显著性（P < 0.036）。与对照组相比，超声在线组穿刺所需的椎间隙数量减少（P < 0.036）。腰麻针的操作次数显著减少（P < 0.036）。
腰椎实时超声扫描是一种简单的操作。它能准确显示针尖位置，有助于腰麻-硬膜外联合麻醉的实施。
