Koo B-N, Hong J-Y, Kim J E, Kil H K
Assistant Professor, Department of Anaesthesiology & Pain Medicine, Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Anaesthesia. 2009 Oct;64(10):1072-6. doi: 10.1111/j.1365-2044.2009.06031.x.
Although the anatomy of the spinal cord and its associated structures have been well defined, the effects of body position relevant to neuraxial blockade have not been elucidated. This study was designed to determine the effect of body position on the end of the dural sac in children. After induction of anaesthesia, ultrasound examination was performed to evaluate the location of the dural sac end in the lateral position with a straight back and knee, and in the lateral position with the knees, legs, and neck flexed. The level of the end of the dural sac was determined in relation to the vertebrae. Our data demonstrate that the dural sac shifts significantly cephalad in the lateral flexed position used for neuraxial blockade (p < 0.001). These results suggest that the safety margin to avoid dural puncture during hiatal or S2-3 approach for caudal block can be increased in younger children.
尽管脊髓及其相关结构的解剖已得到明确界定，但与神经轴阻滞相关的身体姿势影响尚未阐明。本研究旨在确定身体姿势对儿童硬脊膜囊末端的影响。麻醉诱导后，进行超声检查以评估在背部挺直且膝盖伸直的侧卧位以及膝盖、腿部和颈部屈曲的侧卧位时硬脊膜囊末端的位置。根据椎骨确定硬脊膜囊末端的水平。我们的数据表明，在用于神经轴阻滞的侧屈位时，硬脊膜囊显著向头侧移位（p < 0.001）。这些结果表明，在年幼儿童中，在进行裂孔或S2 - 3入路骶管阻滞时避免硬脊膜穿刺的安全 margin 可以增加。
