Palencia M, Guasch E, Navas D, Gilsanz F
Servicio de Anestesiología y Reanimación, Hospital Universitario "La Paz", Madrid.
Rev Esp Anestesiol Reanim. 2006 Mar;53(3):139-44.
Predicting technical difficulties in performing an epidural block can affect the anesthesiologist's choice of technique or decisions about who should carry it out. Our aim was to determine patient characteristics associated with difficulty in performing an epidural block for obstetric analgesia.
We designed a prospective observational study in 540 pregnant women who requested epidural analgesia for obstetric labor. Patient characteristics (age, weight, height), anatomical features (body constitution, visible and/or palpable spinal apophyses, structural anomalies), technical features (number of attempts, repositioning of the needle), anesthesiologist's experience (resident or staff), block success, time taken to accomplish the procedure, and obstetrical variables (parity, gestational age, cervical dilatation).
The factor that best correlates with puncture difficulty in the obstetric patient is the presence of visible or palpable spinal apophyses and palpation prior to carrying out the block. Factors like weight, body constitution, or anesthesiologist's experience seem to influence the rate of success or failure of the epidural block for obstetric analgesia, although to a lesser degree.
The most important factor for predicting success of an epidural block for obstetric analgesia in our practice is the presence of palpable spinal apophyses.
预测硬膜外阻滞操作中的技术困难会影响麻醉医生对技术的选择或关于应由谁来实施该操作的决策。我们的目的是确定与产科镇痛硬膜外阻滞困难相关的患者特征。
我们对540名要求进行产科分娩硬膜外镇痛的孕妇设计了一项前瞻性观察研究。记录患者特征（年龄、体重、身高）、解剖特征（身体体质、可见和/或可触及的脊柱突、结构异常）、技术特征（穿刺次数、针头重新定位）、麻醉医生的经验（住院医生或 staff）、阻滞成功率、完成操作所需时间以及产科变量（产次、孕周、宫颈扩张）。
与产科患者穿刺困难最相关的因素是存在可见或可触及的脊柱突以及在实施阻滞前进行触诊。体重、身体体质或麻醉医生的经验等因素似乎会影响产科镇痛硬膜外阻滞的成功率或失败率，尽管程度较小。
在我们的实践中，预测产科镇痛硬膜外阻滞成功的最重要因素是存在可触及的脊柱突。
