Larsson J, Gordh T E
Department of Public Health and Caring Sciences, University of Uppsala, Uppsala, Sweden.
Acta Anaesthesiol Scand. 2010 Jul;54(6):761-3. doi: 10.1111/j.1399-6576.2009.02189.x. Epub 2009 Dec 21.
When using epidural anaesthesia (EDA) for pain relief after major surgery, a failure rate of 10% is common. A crucial step in improving the care of patients with EDA is to define the position of the epidural catheter. The aim of this study was to investigate how much time it takes to determine whether the block is sufficient by assessing the extent of loss of cold sensation before induction of anaesthesia.
One hundred patients listed for abdominal surgery were included in the study. After an epidural catheter had been inserted and an intrathecal or an intravenous position had been made unlikely by the use of a test dose, the patient was given a bolus dose of local anaesthetic plus an opioid in the epidural catheter. The epidural block was tested every 2 min, starting at 5 min and ending at 15 min. When at least four segments were blocked bilaterally, the testing was stopped, the time was noted and the patient was anaesthetised.
An epidural block was demonstrated after 5-6 min in 37 patients, after 7-8 min in 43 additional patients and after 9-10 min in 15 patients. In one patient, it took 12 min and in three patients, it took 15 min. In two patients, no epidural block could be demonstrated.
Testing an epidural anaesthetic before the induction of anaesthesia takes only 5-10 extra minutes. Knowing whether the catheter is correctly placed means better quality of care, giving the anaesthetist better prerequisites for taking care of the patient post-operatively.
在大手术后使用硬膜外麻醉（EDA）进行疼痛缓解时，10%的失败率很常见。改善硬膜外麻醉患者护理的关键步骤是确定硬膜外导管的位置。本研究的目的是通过评估麻醉诱导前冷觉丧失的程度来调查确定阻滞是否充分需要多长时间。
本研究纳入了100例计划进行腹部手术的患者。在插入硬膜外导管并通过使用试验剂量排除鞘内或静脉内位置后，向硬膜外导管内给予患者一剂局部麻醉药加一种阿片类药物。从5分钟开始，每2分钟测试一次硬膜外阻滞，至15分钟结束。当双侧至少有四个节段被阻滞时，停止测试，记录时间并对患者进行麻醉。
37例患者在5 - 6分钟后显示硬膜外阻滞，另外43例患者在7 - 8分钟后显示，15例患者在9 - 10分钟后显示。1例患者用时12分钟，3例患者用时15分钟。2例患者未显示硬膜外阻滞。
在麻醉诱导前测试硬膜外麻醉仅需额外5 - 10分钟。知道导管是否正确放置意味着更好的护理质量，为麻醉师术后照顾患者提供了更好的前提条件。
