Ponde Vrushali C, Bedekar Vinit V, Desai Ankit P, Puranik Kiran A
Children Anaesthesia Services & Surya Children Hospital, Santacruz (West), Mumbai, India.
Paediatr Anaesth. 2017 Oct;27(10):1010-1014. doi: 10.1111/pan.13212. Epub 2017 Aug 10.
Caudo-lumbar and caudo-thoracic epidural anesthesia is an established technique that carries a low risk of dural puncture or spinal cord trauma in infants. Traditionally catheter advancement is based on external measurements. However, malpositioning of catheters are known to occur. We hypothesized that caudal-epidural catheters inserted under real-time ultrasound guidance may be more accurate than the accuracy of the measurements traditionally used for their placement.
We studied 25 patients, aged 2 days to 5 months, posted for abdominal or thoracic surgery, receiving general anesthesia followed by caudo-epidural continuous block. External measurement defined as the distance from the caudal space and the surgically congruent vertebral level was measured in centimeters with the back gently flexed. Subsequently, a caudo-epidural block was performed in the same position. The epidural catheter insertion was followed under real-time ultrasound guidance till the predetermined vertebral level was reached. The actual length placed under real-time ultrasound scan was defined as the actual length. The high-frequency probe was placed longitudinal and paramedian to the spine. The vertebral level was determined by identifying the lumbosacral junction in longitudinal saggital view and counting the vertebrae up from L5. The catheter length at the skin was compared with the length recorded by external measurement.
The actual length placed under real-time ultrasound scan were consistently longer than the external distance between the caudal space and selected vertebral level. The mean values of ultrasound were higher than the mean values of external measurement with a difference of 4.28 cm. Accuracy was not affected by age or affected by the selected vertebral level in the age group we studied.
We conclude that catheters placed under ultrasound guidance are more accurate than the traditional method developed before the advent of ultrasound in young infants.
腰骶部和胸腰部硬膜外麻醉是一种成熟的技术，在婴儿中发生硬膜穿刺或脊髓损伤的风险较低。传统上，导管推进是基于外部测量。然而，已知会发生导管位置不当的情况。我们假设，在实时超声引导下插入的骶管硬膜外导管可能比传统放置方法所使用的测量方法更准确。
我们研究了25例年龄在2天至5个月之间、拟行腹部或胸部手术的患者，这些患者接受全身麻醉后进行骶管硬膜外持续阻滞。外部测量定义为从骶管间隙到手术对应椎体水平的距离，在背部轻轻弯曲的情况下以厘米为单位进行测量。随后，在相同位置进行骶管硬膜外阻滞。在实时超声引导下进行硬膜外导管插入，直至到达预定的椎体水平。在实时超声扫描下放置的实际长度定义为实际长度。高频探头纵向放置在脊柱旁正中。通过在纵向矢状视图中识别腰骶关节并从L5向上计数椎体来确定椎体水平。将皮肤处的导管长度与外部测量记录的长度进行比较。
实时超声扫描下放置的实际长度始终长于骶管间隙与选定椎体水平之间的外部距离。超声测量的平均值高于外部测量的平均值，相差4.28厘米。在我们研究的年龄组中，准确性不受年龄影响，也不受选定椎体水平的影响。
我们得出结论，在超声引导下放置的导管比在超声出现之前开发的传统方法在幼儿中更准确。
