Edanaga Mitsutaka, Yamauchi Masanori, Yamakage Michiaki
Department of Anesthesiology, Sapporo Medical University, School of Medicine, Sapporo 060-8543.
Masui. 2013 Apr;62(4):488-94.
We reviewed the indications for and features of preoperative epidural catheterization under radiographic monitoring. This technique allows easy epidural catheterization and achieves reliable effects for postoperative analgesia, reducing the burden on patients, particularly those with morbid obesity, strong transformation of spine or unilateral operations such as total knee arthroplasty or pneumectomy. Standard methods are as follows: (1) the patient is placed in a prone position on the fluoroscopic table; and (2) the operator usually stands to the left of the patient. First, a 23 G, long needle is introduced for local anesthesia and to confirm depth and angle from the skin to the basal part of the spinous process. An 18 G Tuohy needle is advanced to the epidural space under real-time radiographic monitoring. It is important that the operator advances the catheter to the epidural space on the operative side (right, left or middle). Finally, confirmation is made under radiographic imaging that the catheter remains at the back of the epidural space. Preoperative epidural catheterization under radiographic monitoring is a safe, reliable, and educational method.
我们回顾了影像学监测下术前硬膜外导管置入的适应证及特点。该技术可使硬膜外导管置入操作简便，并能为术后镇痛取得可靠效果，减轻患者负担，尤其是对于病态肥胖、脊柱严重变形或进行全膝关节置换术或肺切除术等单侧手术的患者。标准方法如下：（1）患者俯卧于透视台上；（2）术者通常站在患者左侧。首先，引入一根23G长针进行局部麻醉，并确认从皮肤到棘突基部的深度和角度。在实时影像学监测下将一根18G Tuohy针推进至硬膜外间隙。术者将导管推进至手术侧（右侧、左侧或中间）的硬膜外间隙非常重要。最后，通过影像学成像确认导管仍位于硬膜外间隙后方。影像学监测下的术前硬膜外导管置入是一种安全、可靠且有指导意义的方法。
