Zhang Kai, Bhatia Sanjay, Oh Michael, Whiting Donald
Neurosurgical Department, Beijing Tiatan Hospital, Beijing, China.
Stereotact Funct Neurosurg. 2009;87(5):292-6. doi: 10.1159/000226670. Epub 2009 Jul 3.
BACKGROUND/AIMS: Placement of paddle electrodes for spinal cord stimulation is usually performed under local anesthesia as the patient must be alert and cooperative during the procedure. This is often difficult, and involves significant discomfort for the patient. We explore the placement of spinal cord stimulators (SCS) under epidural anesthesia.
Fifteen consecutive patients underwent single-shot epidural anesthesia prior to placement of the SCS. Patient perception of paresthesias during intraoperative stimulation was compared to preoperative pain dermatomes indicated by the patient. The ability to produce paresthesias as well as the voltage required to produce paresthesias under anesthesia were recorded. Patient demographics, amount and concentration of epidural drugs, use of local anesthetic or sedatives, and any complications were also recorded.
Epidural anesthesia was successfully induced in 14 patients. All patients were alert and cooperative. Paresthesias in appropriate dermatomes were induced in all patients. No local anesthetic or sedatives were used. The voltage required to induce paresthesias was double that required to maintain stimulation once the epidural had worn off.
Epidural anesthesia provides a safe and effective means of placing SCS with paddle-type electrodes. There is no patient discomfort, and paresthesias are consistently elicited in appropriate areas in all patients.
背景/目的：脊髓刺激器的极板电极放置通常在局部麻醉下进行，因为手术过程中患者必须保持清醒并配合。这往往很困难，且会给患者带来明显不适。我们探讨在硬膜外麻醉下放置脊髓刺激器（SCS）。
15例连续患者在放置SCS之前接受单次硬膜外麻醉。将术中刺激时患者对感觉异常的感知与患者术前指出的疼痛皮节进行比较。记录麻醉下产生感觉异常的能力以及产生感觉异常所需的电压。还记录了患者的人口统计学资料、硬膜外药物的用量和浓度、局部麻醉药或镇静剂的使用情况以及任何并发症。
14例患者成功诱导硬膜外麻醉。所有患者均保持清醒并配合。所有患者均在适当的皮节诱发了感觉异常。未使用局部麻醉药或镇静剂。硬膜外麻醉消退后，诱发感觉异常所需的电压是维持刺激所需电压的两倍。
硬膜外麻醉为使用极板型电极放置SCS提供了一种安全有效的方法。患者无不适，且所有患者均能在适当区域持续引出感觉异常。
