Najman Ilana Esquenazi, Frederico Thiago Nouer, Segurado Arthur Vitor Rosenti, Kimachi Pedro Paulo
Hospital Infantil Ismélia Silveira, Brazil.
Rev Bras Anestesiol. 2011 Jan-Feb;61(1):95-109. doi: 10.1016/S0034-7094(11)70011-3.
Caudal epidural anesthesia is the most popular regional anesthesia technique used in children. With advanced age, only the relative difficulty in localizing the sacral hiatus limits its use. However, in adults this technique has been widely used to control chronic pain by adjuvant use of fluoroscopy. Thus, the ability to locate the hiatus and define anatomical variations is the main determinant of the success and safety of caudal epidural anesthesia. In this context, the use of the ultrasound in caudal epidural anesthesia has been increasing. The objective of this review was to determine the role of the ultrasound in caudal epidural anesthesia and to demonstrate that this technique, widely used in children, is also useful and can be used in adults.
A review of the literature on sacral anatomy and the anesthetic technique necessary to perform caudal epidural anesthesia was undertaken. Recent studies in ultrasound-guided caudal epidural anesthesia both in children and adults were also included.
Despite its limitations, the ultrasound can be a useful tool to position the needle in the caudal space. It allows prompt identification of the sacral anatomy and real-time visualization of the injection. Considering it is portable, non-invasive, and free of radiation exposure, it is an attractive technique in the operating room especially in difficult cases. However, since its use in neuroaxis anesthesia is very primitive, more studies are necessary to make it a routine technique in anesthetic practice.
骶管硬膜外麻醉是儿童最常用的区域麻醉技术。随着年龄增长，仅骶裂孔定位相对困难限制了其应用。然而，在成人中，该技术已通过辅助使用荧光透视广泛用于控制慢性疼痛。因此，定位骶裂孔及明确解剖变异的能力是骶管硬膜外麻醉成功与安全的主要决定因素。在此背景下，超声在骶管硬膜外麻醉中的应用日益增加。本综述的目的是确定超声在骶管硬膜外麻醉中的作用，并证明这种在儿童中广泛使用的技术在成人中也有用且可应用。
对有关骶骨解剖及实施骶管硬膜外麻醉所需麻醉技术的文献进行了综述。还纳入了近期关于儿童和成人超声引导下骶管硬膜外麻醉的研究。
尽管存在局限性，但超声可作为将穿刺针置于骶管腔的有用工具。它能迅速识别骶骨解剖结构并实时观察注射情况。鉴于其便携、无创且无辐射暴露，在手术室尤其是困难病例中是一种有吸引力的技术。然而，由于其在神经轴麻醉中的应用非常原始，需要更多研究使其成为麻醉实践中的常规技术。
