Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea.
Korean J Anesthesiol. 2011 Nov;61(5):377-81. doi: 10.4097/kjae.2011.61.5.377. Epub 2011 Nov 23.
Traumatic placement of a needle during a neuraxial blockade has been related to many complications such as postdural puncture headache, trauma to neural structures and even spinal hematoma, causing permanent neurologic deficits. Although efforts to minimize the complications caused by traumatic neuraxial blockade have been made, nothing was found to be clear. The authors investigated the predictors of difficult neuraxial blockade using the first puncture success and number of attempts as measures to assess the difficulty.
In this prospective observational study, 253 patients scheduled for elective surgery underwent spinal or epidural anesthesia. Patient data (age, sex, height, weight, body mass index, and quality of anatomical landmarks), the provider's level of experience, type of blockade (spinal or epidural), needle type/gauge and the distance from skin to subarachnoid or epidural space were recorded. Significant variables were first determined by Student's t-test and Pearson's chi square test and then logistic and Poisson regression tested the association of the first puncture success and number of attempts with the significant variables.
The provider's level of experience and the distance from skin to subarachnoid or epidural space were significant in logistic and Poisson regression. Body mass index was significant only in Poisson regression and the quality of anatomical landmarks was significant only in logistic regression.
Provider's level of experience and the distance from skin to subarachnoid or epidural space influenced the difficulty in performing a neuraxial blockade.
在椎管内阻滞过程中，由于针的创伤性放置，可能会导致许多并发症，如硬膜后穿刺头痛、神经结构损伤，甚至脊髓血肿，导致永久性神经功能缺损。尽管已经努力减少由创伤性椎管内阻滞引起的并发症，但没有找到明确的方法。作者使用首次穿刺成功和尝试次数作为评估困难程度的指标，研究了困难性椎管内阻滞的预测因素。
在这项前瞻性观察性研究中，253 名计划接受择期手术的患者接受了脊髓或硬膜外麻醉。记录了患者数据（年龄、性别、身高、体重、体重指数和解剖标志的质量）、提供者的经验水平、阻滞类型（脊髓或硬膜外）、针的类型/规格以及从皮肤到蛛网膜下腔或硬膜外腔的距离。首先通过学生 t 检验和皮尔逊卡方检验确定显著变量，然后通过逻辑和泊松回归检验首次穿刺成功和尝试次数与显著变量的相关性。
提供者的经验水平和从皮肤到蛛网膜下腔或硬膜外腔的距离在逻辑和泊松回归中是显著的。体重指数仅在泊松回归中显著，解剖标志的质量仅在逻辑回归中显著。
提供者的经验水平和从皮肤到蛛网膜下腔或硬膜外腔的距离影响了进行椎管内阻滞的难度。
