Srinivasan K Kallidaikurichi, Deighan M, Crowley L, McKeating K
Department of Anaesthesia, National Maternity Hospital, Dublin, Ireland.
Department of Anaesthesia, National Maternity Hospital, Dublin, Ireland.
Int J Obstet Anesth. 2014 Aug;23(3):206-12. doi: 10.1016/j.ijoa.2014.02.004. Epub 2014 Feb 20.
Spinal anaesthesia performed at levels higher than the L3-4 intervertebral space may result in spinal cord injury. Our aim was to establish a protocol to reduce the chance of spinal anaesthesia performed at or above L2-3.
One hundred and ten consenting patients at 32weeks of gestation or greater scheduled for non-emergency caesarean section under spinal anaesthesia were randomly allocated to have needle insertion performed at an intervertebral space determined by one of two landmark techniques. In Group A, if the intercristal line intersected an intervertebral space, this space was selected or if the intercristal line intersected a spinous process the space immediately above was selected. In Group B, if the intercristal line intersected an intervertebral space or a spinous process, the intervertebral space immediately below was chosen. The actual intervertebral space chosen was identified using ultrasound by a blinded investigator.
In Group A, an intervertebral space at or above L2-3 was marked in 25 (45.5%) patients compared with 4 (7.3%) in Group B (P <0.001). In 5/55 (9.1%) patients in Group A, the intervertebral space initially chosen was L1-2 whereas this occurred in no patient in Group B. There was no difference between groups in number of needle passes or attempts, onset of block at 5, 10 and 15min or need for rescue analgesia.
Our data suggest that when performing spinal anaesthesia in pregnant patients, if the intercristal line intersects an intervertebral space then the space below should be chosen and if the intercristal line intersects a spinous process then the interspace below should be chosen. This will reduce the incidence of spinal anaesthesia performed at or above L2-3.
在高于L3 - 4椎间隙水平实施脊髓麻醉可能导致脊髓损伤。我们的目的是制定一项方案以降低在L2 - 3或更高水平实施脊髓麻醉的几率。
110例孕周32周及以上、同意接受脊髓麻醉下非急诊剖宫产的患者被随机分配，通过两种体表标志技术之一来确定穿刺椎间隙进行穿刺。A组中，如果髂嵴连线与一个椎间隙相交，则选择该间隙；如果髂嵴连线与一个棘突相交，则选择其上方紧邻的间隙。B组中，如果髂嵴连线与一个椎间隙或一个棘突相交，则选择其下方紧邻的椎间隙。由一名不知情的研究者使用超声确定实际选择的椎间隙。
A组中，25例（45.5%）患者的穿刺间隙为L2 - 3或更高水平，而B组为4例（7.3%）（P<0.001）。A组55例患者中有5例（9.1%）最初选择的椎间隙为L1 - 2，而B组无此情况。两组在穿刺针穿刺次数或尝试次数、5分钟、10分钟和15分钟时的阻滞起效情况或是否需要补救镇痛方面无差异。
我们的数据表明，在为孕妇实施脊髓麻醉时，如果髂嵴连线与一个椎间隙相交，则应选择下方的间隙；如果髂嵴连线与一个棘突相交，则也应选择下方的间隙。这将降低在L2 - 3或更高水平实施脊髓麻醉的发生率。
