硬膜外/脊髓联合麻醉：针内针技术还是不同间隙穿刺技术？

Combined epidural/spinal anaesthesia: needle-through-needle or separate spaces?

作者信息

Backe S K, Sheikh Z, Wilson R, Lyons G R

机构信息

St. James's University Hospital, Leeds, UK.

出版信息

Eur J Anaesthesiol. 2004 Nov;21(11):854-7. doi: 10.1017/s0265021504000171.

DOI:10.1017/s0265021504000171

PMID:15717699

Abstract

BACKGROUND AND OBJECTIVE

This prospective, randomized and blinded study compared the performance of a new needle-through-needle (NTN) kit (Epistar; Medimex, Germany) with the double-space technique for providing combined spinal epidural anaesthesia during Caesarean section.

METHODS

Following local Ethics Committee approval and patient consent, 200 females were randomized to receive combined spinal epidural anaesthesia by the double-space (n = 100) or NTN (n = 100) technique. The frequency with which the intrathecal component could achieve a T5 block to touch for Caesarean section without the need for epidural augmentation or an alternative technique was determined. The time from start of procedure to achieving a block height to T5 was recorded. Pain and backache at insertion, and at 24 h follow-up were recorded using a visual analogue scale. To remove any bias due to posture, 50% of each group were further randomized to receive their block in the sitting or in the left lateral position. To evaluate improvement of performance over time the success in the first 100 study patients were compared to the success in the second 100.

RESULTS

A successful block to T5 with the double-space and NTN techniques were 80 vs. 54, odds ratio 0.29. Failure to enter the intrathecal space once the epidural space had been located occurred in 29 patients in the NTN group. Time to readiness for surgery was 15 min (95% confidence interval (CI): 12.7-17.4) and 12.9 min (95% CI: 11.5-14.3) for the double-space and NTN techniques, respectively. The median (interquartile range) visual analogue scores for discomfort at insertion were 30 (12.5-51.5) and 32 (12.75-60) and for postoperative backache 0 (0-10) and 0 (0-10.75) in the double-space and NTN groups, respectively. The number of epidural augmentations was similar in both the groups and posture made no difference. There was a tendency to increased success in the second half of the study.

CONCLUSION

The double-space technique had a greater success rate than the NTN technique.

摘要

背景与目的

本前瞻性、随机双盲研究比较了一种新型套针穿刺（NTN）套件（Epistar；德国Medimex公司）与双间隙技术在剖宫产联合蛛网膜下腔硬膜外麻醉中的应用效果。

方法

经当地伦理委员会批准并获得患者同意后，将200名女性随机分为两组，每组100例，分别接受双间隙技术（n = 100）或NTN技术（n = 100）进行联合蛛网膜下腔硬膜外麻醉。确定蛛网膜下腔部分在剖宫产时无需硬膜外辅助或采用其他技术即可达到T5触觉阻滞的频率。记录从开始操作到达到T5阻滞平面的时间。使用视觉模拟评分法记录穿刺时以及术后24小时的疼痛和背痛情况。为消除因体位造成的任何偏差，每组50%的患者进一步随机分为坐位或左侧卧位接受阻滞。为评估随着时间推移技术性能的改进情况，将前100例研究患者的成功率与后100例患者的成功率进行比较。

结果

双间隙技术和NTN技术成功达到T5阻滞的例数分别为80例和54例，比值比为0.29。NTN组有29例患者在确定硬膜外腔后未能进入蛛网膜下腔。双间隙技术和NTN技术的手术准备时间分别为15分钟（95%置信区间（CI）：12.7 - 17.4）和12.9分钟（95%CI：11.5 - 14.3）。双间隙组和NTN组穿刺时不适的视觉模拟评分中位数（四分位间距）分别为30（12.5 - 51.5）和32（12.75 - 60），术后背痛的评分分别为0（0 - 10）和0（0 - 10.75）。两组硬膜外辅助的次数相似，体位对结果无影响。研究后半期有成功率增加的趋势。