Gnaho Alexandre, Nguyen Vinh, Villevielle Thierry, Frota Melina, Marret Emmanuel, Gentili Marc E
Department of Anesthesia and Intensive Care, Hôpital d’Instruction des Armées (HIA Begin), Saint Mandé, France.
Rev Bras Anestesiol. 2012 Jul;62(4):520-30. doi: 10.1016/S0034-7094(12)70150-2.
To assess the accuracy of the ultrasound (US) to predict the depth to reach lumbar intrathecal and epidural spaces in order to decrease the number of puncture attempts.
Thirty-one patients (25 males and 6 females), ASA I or II participated in this study. The transversal ultrasound image of the lumbar spine was obtained at the level of the L3-L4 space. An anesthesiologist without prior information performed the spinal anesthesia through the predicted target area. The distance between the skin and the anterior portion of the flavum ligamentum which is supposedly the bottom limit of the intrathecal depth or an approximation of the depth of the epidural space (ED-US) was measured by ultrasound and it was compared with the distance between the skin and the anterior portion of the flavum ligamentum on the needle (ED-N).
ED-US and ED-N were respectively 5.15±0.95cm and 5.14±0.97cm; these distances were not significantly different (p>0.0001). A significant correlation r=0.982 [95% CI 0.963-0.992, p>0.0001] was observed between the ED-US and ED-N measurements. Bland-Altman analysis showed an accuracy of 0.18cm; tolerated variations ranged from -0.14cm to -0.58cm.
This study supports the idea that the US transversal plane allows the identification of axial anatomical structures and provides physicians with efficient information to perform spinal anesthesia.
评估超声预测腰椎鞘内和硬膜外间隙穿刺深度的准确性，以减少穿刺尝试次数。
31例患者（25例男性，6例女性），ASA分级为I或II级，参与本研究。在L3-L4间隙水平获取腰椎的横向超声图像。一名事先不知情的麻醉医生通过预测的目标区域实施脊髓麻醉。通过超声测量皮肤与黄韧带前部之间的距离（假定为鞘内深度的下限或硬膜外间隙深度的近似值，即ED-US），并将其与穿刺针上皮肤与黄韧带前部之间的距离（ED-N）进行比较。
ED-US和ED-N分别为5.15±0.95cm和5.14±0.97cm；这些距离无显著差异（p>0.0001）。ED-US和ED-N测量值之间存在显著相关性，r=0.982 [95% CI 0.963-0.992，p>0.0001]。Bland-Altman分析显示准确性为0.18cm；可耐受的差异范围为-0.14cm至-0.58cm。
本研究支持以下观点，即超声横向平面能够识别轴向解剖结构，并为医生实施脊髓麻醉提供有效信息。
