一些关于在没有导管的情况下硬膜外镇痛不完全覆盖的硬膜外造影解释。

Some epidurographic explanations for incomplete epidural analgesia coverage in the absence of a catheter.

机构信息

Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; Assistant Consultant, Department of Anaesthesia and Pain Management, King AbdulAziz Medical City Saudi Arabia, Riyadh, Saudi Arabia; Lecturer, Department of Anesthesia, Alexandria University, Alexandria, Egypt.

出版信息

J Clin Anesth. 2013 Nov;25(7):565-71. doi: 10.1016/j.jclinane.2013.05.006. Epub 2013 Sep 2.

DOI:10.1016/j.jclinane.2013.05.006

PMID:24008196

Abstract

STUDY OBJECTIVE

To determine the impact of the plica mediana dorsalis (PMD) on injected contrast media spread in the epidural space.

DESIGN

Prospective interventional study.

SETTING

Academic medical center.

PATIENTS

30 chronic pain patients ranging in age from 37 to 71 years, undergoing epidural steroid injection.

INTERVENTIONS AND MEASUREMENTS

Epidurograms were evaluated for the 1) presence or absence of a PMD and 2) bilateral differential density and the extent of contrast spread on either side of the midline, horizontally and vertically.

RESULTS

The PMD (defined as midline radiolucency in epidurograms) was observed in (80%) 24/30 patients based on the epidurograms that were evaluated. Denser contrast spread on one side was found in (79%) 19/24 patients who had the PMD and in (33%) 2/6 patients who did not have the PMD (P = 0.03). Horizontal and vertical asymmetrical spread of the contrast was observed in (67%) 16 of 24 patients with the PMD and in (50%) 3 of 6 of patients without the PMD in each direction independently.

CONCLUSION

The difference in density of contrast spread on either side of the midline carries important clinical implications in understanding the pathogenesis of inadequate epidural analgesia and/or unilateral excessive motor weakness or numbness.

摘要

研究目的

确定背正中隔带（PMD）对硬膜外腔注射对比剂扩散的影响。

设计

前瞻性干预研究。

地点

学术医疗中心。

患者

30 名年龄在 37 岁至 71 岁之间的慢性疼痛患者，行硬膜外类固醇注射治疗。

干预措施和测量

对硬膜外造影进行评估，以确定 1）是否存在 PMD，2）双侧差异密度以及中线两侧、水平和垂直方向的对比剂扩散范围。

结果

根据评估的硬膜外造影，24/30 例（80%）患者观察到 PMD（硬膜外造影中定义为中线透亮带）。24 例存在 PMD 的患者中，有 19 例（79%）一侧对比剂扩散更密集，而 6 例不存在 PMD 的患者中有 2 例（33%）（P=0.03）。24 例存在 PMD 的患者中，16 例（67%）观察到对比剂水平和垂直扩散不对称，而 6 例不存在 PMD 的患者中，每侧有 3 例（50%）观察到不对称（P=0.004）。