Palacio Abizanda F J, Reina M A, Fornet I, López A, López López M A, Morillas Sendín P
Servicio de Antestesiología y Reanimación, Hospital General Universitario Gregorio Marañon, Madrid.
Rev Esp Anestesiol Reanim. 2009 Jan;56(1):21-6. doi: 10.1016/s0034-9356(09)70316-0.
To determine the incidence of paresthesia during lumbar puncture performed with the patient in different positions.
A single-blind prospective study of patients scheduled for elective cesarean section, randomized to 3 groups. In group 1 patients were seated in the direction of the long axis of the table, with heels resting on the table. In group 2 they were seated perpendicular to the long axis of the table, with legs hanging from the table. In group 3 they were in left lateral decubitus position. Lumbar punctures were performed with a 27-gauge Whitacre needle.
One hundred sixty-eight patients (56 per group) were enrolled. Paresthesia occurred most often in group 3 (P = .009). We observed no differences in blood pressure after patients moved from decubitus position to the assigned position. Nor did we observe between-group differences in blood pressure according to position taken during puncture.
Puncture undertaken with the patient seated, heels on the table and knees slightly bent, is associated with a lower incidence of paresthesia than puncture performed with the patient seated, legs hanging from the table. Placing the patient's heels on the table requires hip flexion and leads to anterior displacement of nerve roots in the dural sac. Such displacement would increase the nerve-free zone on the posterior side of the sac, thereby decreasing the likelihood of paresthesia during lumbar puncture. A left lateral decubitus position would increase the likelihood of paresthesia, possibly because the anesthetist may inadvertently not follow the medial line when inserting the needle.
确定患者处于不同体位时进行腰椎穿刺时感觉异常的发生率。
对计划进行择期剖宫产的患者进行单盲前瞻性研究，随机分为3组。第1组患者沿手术台长轴方向就座，脚跟放在手术台上。第2组患者垂直于手术台长轴就座，双腿垂于手术台外。第3组患者取左侧卧位。使用27号惠特克针进行腰椎穿刺。
共纳入168例患者（每组56例）。感觉异常在第3组中最常出现（P = 0.009）。我们观察到患者从卧位移动到指定体位后血压无差异。根据穿刺时所取体位，我们也未观察到组间血压差异。
患者就座、脚跟放在手术台上且膝盖微屈时进行穿刺，与患者就座、双腿垂于手术台外时进行穿刺相比，感觉异常的发生率较低。将患者脚跟放在手术台上需要髋关节屈曲，并导致硬脊膜囊内神经根向前移位。这种移位会增加硬脊膜囊后侧的无神经区，从而降低腰椎穿刺时感觉异常的可能性。左侧卧位会增加感觉异常的可能性，可能是因为麻醉师在进针时可能会无意中偏离中线。
