Browne Ingrid M, Birnbach David J, Stein Deborah J, O'Gorman David A, Kuroda Maxine
Departments of Anesthesiology, University of Miami School of Medicine, Miami, Florida; and St. Luke's-Roosevelt Hospital Center, College of Physicians and Surgeons of Columbia University, New York, New York.
Anesth Analg. 2005 Aug;101(2):535-540. doi: 10.1213/01.ANE.0000157162.41892.6A.
When using the needle-through-needle combined spinal-epidural (CSE) technique for labor analgesia, failure to obtain cerebrospinal fluid (CSF), paresthesias, and intrathecal or intravascular migration of the catheter are of concern. Epidural needles with spinal needle apertures, such as the back-hole Espocan (ES) needles, are available and may reduce these risks. We describe the efficacy and adverse events associated with a modified epidural needle (ES) versus a conventional Tuohy needle for CSE. One-hundred parturients requesting labor analgesia (CSE) were randomized into 2 groups: 50-ES 18-gauge modified epidural needle with 27-gauge Pencan atraumatic spinal needle, 50-conventional 18-gauge Tuohy needle with 27-gauge Gertie Marx atraumatic spinal needle. Information on intrathecal or intravascular catheter placement, paresthesia on introduction of spinal needle, failure to obtain CSF through the spinal needle after placement of epidural needle, unintentional dural puncture, and epidural catheter function was obtained. No intrathecal catheter placement occurred in either group. Rates of intravascular catheter placement and unintentional dural puncture were similar between the groups. Significant differences were noted regarding spinal needle-induced paresthesia (14% ES versus 42% Tuohy needles, P = 0.009) and failure to obtain CSF on first attempt (8% ES versus 28% Tuohy needles, P < 0.02). Use of ES needles for CSE significantly reduces paresthesia associated with the insertion of the spinal needle and is associated with more frequent successful spinal needle placement on the first attempt.
The use of modified epidural needles with a back hole for combined spinal-epidural technique significantly reduces paresthesia associated with the insertion of the spinal needle and is associated with more frequent successful spinal needle placement on the first attempt.
在使用针内针联合脊髓硬膜外（CSE）技术进行分娩镇痛时，未能获取脑脊液（CSF）、出现感觉异常以及导管鞘内或血管内移位是令人担忧的问题。带有脊髓针孔的硬膜外针，如背孔埃斯波坎（ES）针，已经有了，可能会降低这些风险。我们描述了一种改良硬膜外针（ES）与传统的Tuohy针用于CSE的疗效和不良事件。100名要求进行分娩镇痛（CSE）的产妇被随机分为两组：50名使用18号改良硬膜外ES针和27号Pencan无损伤脊髓针，50名使用传统的18号Tuohy针和27号格蒂·马克思无损伤脊髓针。获取了关于鞘内或血管内导管置入、脊髓针置入时的感觉异常、硬膜外针置入后未能通过脊髓针获取脑脊液、意外硬膜穿刺以及硬膜外导管功能的信息。两组均未发生鞘内导管置入。两组血管内导管置入率和意外硬膜穿刺率相似。在脊髓针引起的感觉异常方面存在显著差异（ES针为14%，Tuohy针为42%，P = 0.009），首次尝试未能获取脑脊液方面也有显著差异（ES针为8%，Tuohy针为28%，P < 0.02）。使用ES针进行CSE可显著降低与脊髓针插入相关的感觉异常，并且首次尝试时脊髓针成功置入的频率更高。
使用带有背孔的改良硬膜外针进行联合脊髓硬膜外技术可显著降低与脊髓针插入相关的感觉异常，并且首次尝试时脊髓针成功置入的频率更高。
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