Soltani Mohammadi Sussan, Hassani Marzieh, Marashi Seyed Mojtaba
Department of Anesthesiology, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Anesth Pain Med. 2014 Apr 5;4(2):e13969. doi: 10.5812/aapm.13969. eCollection 2014 May.
previous evidences suggested that traditional sitting position (flexion of knees approximately 90°, and adduction of hips while feet rest on a stool) and hamstring stretch position (sitting position with maximum extension of knees, adduction of hips, and forward bending) both reversed the lumbar lordosis and the number of spinal needle-bone contacts were identical when placing patients in these positions for neuraxial block.
In this study, we suggested that squatting position reverses the lumbar lordosis and reduces the number of spinal needle bone contacts better than a traditional sitting position.
Two hundred and thirty six patients ASA (American Society of Anesthesiologist) class I or II aged 18 to 75 years scheduled for elective surgeries under elective spinal anesthesia were randomized into two groups. We compared the traditional sitting and squatting positions. Our primary endpoint was the number of spinal needle-bone contacts, and secondary endpoint was ease of needle insertion or space identification.
The total number of spinal needle bone contact was statistically lower in the squatting position compared to traditional sitting position group (222 versus 230 respectively, P = 0.01). Insertion of needle was easy in 97 (87%) and 94 (84%) of patients and difficult in 20 (18%) and 17 (15%) of patients in traditional sitting and squatting positions, respectively (P = 0.59 and P = 0.12). Needle insertion was not impossible in any patients.
In squatting position the number of spinal needle-bone contacts was lower compared to the traditional sitting position, nonetheless ease of needle insertion or space identification was the same in the both groups.
先前的证据表明，传统坐姿（膝盖屈曲约90°，双脚放在凳子上时髋关节内收）和腘绳肌拉伸位（膝盖最大程度伸展、髋关节内收且向前弯曲的坐姿）都会使腰椎前凸反转，并且在将患者置于这些位置进行神经轴阻滞时，脊柱穿刺针与骨质的接触次数相同。
在本研究中，我们提出与传统坐姿相比，蹲姿能更好地反转腰椎前凸并减少脊柱穿刺针与骨质的接触次数。
将236例年龄在18至75岁、美国麻醉医师协会（ASA）分级为I或II级、计划在择期脊髓麻醉下进行择期手术的患者随机分为两组。我们比较了传统坐姿和蹲姿。我们的主要终点是脊柱穿刺针与骨质的接触次数，次要终点是穿刺针插入的难易程度或间隙识别情况。
与传统坐姿组相比，蹲姿组脊柱穿刺针与骨质的接触总数在统计学上更低（分别为222次和230次，P = 0.01）。在传统坐姿和蹲姿下，分别有97例（87%）和94例（84%）患者的穿刺针插入容易，20例（18%）和17例（15%）患者的穿刺针插入困难（P = 0.59和P = 0.12）。在任何患者中穿刺针插入均非不可能。
与传统坐姿相比，蹲姿下脊柱穿刺针与骨质的接触次数更低，尽管如此，两组在穿刺针插入的难易程度或间隙识别方面是相同的。
