Onishi Eiko, Yamauchi Masanori
Masui. 2014 Sep;63(9):1011-7.
Ultrasound-guided neuraxial block has provided safe and accurate analgesia. Although the classic anatomical landmark technique is still standard for completing epidural or subarachnoid puncture, it is difficult to identify the anatomical structure in some cases such as pregnant women, obese patients and patients with spinal deformity. Preparatory ultrasound scanning enables to identify the midline and determine the point of insertion, which reduces the number of puncture attempts and failure rate of procedure. Moreover, there are reports about the efficacy of ultrasound guidance in children. Usually, neuraxial block for children is performed under general anesthesia which has some risk for nerve injury and inadequate catheterization. Visualization of epidural and subarachnoid space facilitates an appropriate insertion. Additionally, the utility of ultrasound-guided lumbar puncture has also been reported in emergency department. Cerebrospinal puncture is an important procedure for diagnosis of some critical conditions such as subarachnoid hemorrhage and central nervous system infections. Ultrasound imaging contributes to smooth procedure and fewer complications. This review summarizes the basic ultrasound-guided technique for expected difficult neuraxial block patients, presenting recent findings.
超声引导下的神经轴阻滞已提供了安全且准确的镇痛效果。尽管经典的解剖标志技术仍是完成硬膜外或蛛网膜下腔穿刺的标准方法，但在某些情况下，如孕妇、肥胖患者和脊柱畸形患者，难以识别解剖结构。术前超声扫描能够识别中线并确定穿刺点，这减少了穿刺尝试次数和操作失败率。此外，有关于超声引导在儿童中有效性的报道。通常，儿童的神经轴阻滞是在全身麻醉下进行的，这存在一些神经损伤和置管不当的风险。硬膜外和蛛网膜下腔的可视化有助于正确置管。此外，超声引导下腰椎穿刺在急诊科的应用也有报道。脑脊液穿刺是诊断某些危急病症如蛛网膜下腔出血和中枢神经系统感染的重要操作。超声成像有助于操作顺利进行并减少并发症。本综述总结了针对预期困难的神经轴阻滞患者的基本超声引导技术，并呈现了近期的研究结果。
