de Andrés J, Gomar C, Calatrava P, Gutiérrez M H, Rojas R, Nalda M A
Servicio de Anestesiología, Hospital Clínic i Provincial, Facultad de Medicina, Universidad de Barcelona.
Rev Esp Anestesiol Reanim. 1990 Jan-Feb;37(1):19-22.
Since the existence of negative pressure in the epidural space was reported, its technique of localization has undergone changes directed to improve objectivity, reliability and safety. The aim of the present study was to evaluate a new electronic divide to localize the epidural space, i.e. the Episensor (Palex, Spain). To this end, 71 patients, both males and females, undergoing elective urological surgery and in whom catheterization of the lumbar epidural space had been planned, were prospectively evaluated and randomly assigned to two homogeneous groups. In group I (n = 35) the epidural space was localized by the classical technique of loss of resistance, while in group II the Episensor was used. In both groups several technical parameters, the qualification of the operator and the complications of the procedure were evaluated. There were no significant differences between both groups regarding the quality of epidural blockade or the subjective technical difficulty of the operator. The incidence of complications of the technique of puncture was significantly higher in group II (p less than 0.05); the most common were dura mater puncture in 13 group II patients and in one group I patient (p less than 0.001). There was no correlation between the qualification of the operator and the development of complications. It was concluded that the use of Episensor to localize lumbar epidural space did not improve the effectiveness of blockade but increased the iatrogenic effects of the puncture. Our lack of experience with this new technique and the low negative pressure of lumbar epidural space might have been the causes of the poor results, that we consider as initial in the evaluation of this new method.
自从硬膜外腔负压被报道以来，其定位技术已发生改变，旨在提高客观性、可靠性和安全性。本研究的目的是评估一种用于定位硬膜外腔的新型电子装置，即Episensor（西班牙Palex公司）。为此，对71例计划进行择期泌尿外科手术且拟行腰段硬膜外腔置管的患者进行前瞻性评估，并随机分为两个同质组。在第一组（n = 35）中，通过经典的阻力消失技术定位硬膜外腔，而在第二组中使用Episensor。对两组的几个技术参数、操作者的资质以及操作并发症进行了评估。两组在硬膜外阻滞质量或操作者主观技术难度方面无显著差异。第二组穿刺技术并发症的发生率显著更高（p < 0.05）；最常见的是13例第二组患者和1例第一组患者发生硬脊膜穿刺（p < 0.001）。操作者的资质与并发症的发生之间没有相关性。得出的结论是，使用Episensor定位腰段硬膜外腔并未提高阻滞效果，但增加了穿刺的医源性影响。我们对这种新技术缺乏经验以及腰段硬膜外腔负压较低可能是结果不佳的原因，我们认为这是对这种新方法评估的初步结果。
