Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK.
Int J Obstet Anesth. 2013 Nov;22(4):298-302. doi: 10.1016/j.ijoa.2013.07.002. Epub 2013 Sep 3.
There is much interest in optimal methods of assessing neuraxial block before caesarean delivery. Although cold sensation is commonly used, some evidence suggests that the risk of intraoperative pain may be reduced by assessing light touch. We aimed to determine how neuraxial anaesthesia was managed perioperatively, and whether changes in clinical practice reflected the differing evidence in the literature over six years.
A survey was sent to UK consultant OAA members in 2004, asking how neuraxial block was assessed before caesarean delivery, what was documented, what information was given to the patient, and postoperative follow-up. The survey was repeated in 2010.
Compared to all other methods of assessing neuraxial block, ethyl chloride was the most popular in 2004 (71.8%, 95% CI 68.3-75.0, P < 0.0001) and 2010 (74.6%, 95% CI 70.8-78.3, P < 0.0001). There was a non-significant increase in light touch use from 54% to 60.1%. The upper level of block varied with the modality tested. There was a significant increase in respondents testing with light touch to T5.
Methods of assessing neuraxial block differed from those recommended in the literature. The wide range of modalities, methods of testing and targeted sensory levels suggest that clearer recommendations on best practice for assessment and documentation of neuraxial block before caesarean delivery are required.
人们对评估剖宫产术前脊神经阻滞的最佳方法非常感兴趣。虽然冷觉通常被用于评估，但有证据表明，通过评估轻触觉可以降低术中疼痛的风险。我们旨在确定围手术期如何管理脊神经麻醉，并确定临床实践的变化是否反映了六年多来文献中不同的证据。
2004 年，我们向英国顾问麻醉师协会的 OAA 成员发送了一份调查，询问他们在剖宫产前如何评估脊神经阻滞、记录了哪些内容、向患者提供了哪些信息以及术后随访情况。该调查于 2010 年再次进行。
与评估脊神经阻滞的所有其他方法相比，2004 年和 2010 年乙基氯的使用率最高（71.8%，95%CI68.3-75.0，P<0.0001；74.6%，95%CI70.8-78.3，P<0.0001）。轻触觉的使用率从 54%增加到 60.1%，但无统计学意义。阻滞的上界随所测试的方法而变化。用轻触觉测试 T5 的应答者比例显著增加。
评估脊神经阻滞的方法与文献中的推荐方法不同。所使用的方法多样，测试方法和目标感觉水平各不相同，这表明需要对剖宫产术前评估和记录脊神经阻滞的最佳实践提出更明确的建议。
