McKenzie Christine P, Carvalho Brendan, Riley Edward T
From the Stanford University School of Medicine and Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, CA.
Reg Anesth Pain Med. 2016 May-Jun;41(3):405-10. doi: 10.1097/AAP.0000000000000367.
Intrathecal catheter devices using a catheter-over-needle design and softer flexible material have been introduced to clinical practice with the aim of reducing some of the complications such as postdural puncture headaches and paresthesias seen with previous versions of intrathecal catheters. We present a case series of 5 cesarean deliveries using the Wiley Spinal intrathecal system (Epimed, Johnstown, New York), which was recently approved by the US Food and Drug Administration. The intrathecal catheter system consists of a flexible 23-gauge intrathecal cannula over a 27-gauge pencil-point spinal needle. The placement of the intrathecal catheter was successful in all 5 cases; however, paresthesias in 3 cases and postdural puncture headaches in 2 cases complicated the placement and use of the device. Although the unique catheter-over-needle design facilitates the use of smaller-gauge spinal needles for dural puncture and larger-gauge catheters for medication administration, this case series using the Wiley Spinal suggests that paresthesias and postdural puncture headaches may still limit its widespread utilization. Future studies are needed to determine the true incidence of complications and to determine the role of continuous spinal anesthesia in the obstetric population.
采用针内导管设计和更柔软的柔性材料的鞘内导管装置已引入临床实践，目的是减少一些并发症，如先前版本的鞘内导管所见的硬膜穿刺后头痛和感觉异常。我们报告了一系列5例使用威利脊柱鞘内系统（Epimed，纽约州约翰斯敦）进行剖宫产的病例，该系统最近获得了美国食品药品监督管理局的批准。鞘内导管系统由一根27号铅笔尖脊柱穿刺针外套一根23号柔性鞘内套管组成。5例中鞘内导管放置均成功；然而，3例出现感觉异常，2例出现硬膜穿刺后头痛，使该装置的放置和使用变得复杂。尽管独特的针内导管设计便于使用较细的脊柱穿刺针进行硬膜穿刺，以及使用较粗的导管给药，但这个使用威利脊柱系统的病例系列表明，感觉异常和硬膜穿刺后头痛可能仍然会限制其广泛应用。需要进一步的研究来确定并发症的真实发生率，并确定连续脊麻在产科人群中的作用。
