Wenk Manuel, Massoth Christina, Pöpping Daniel M, Möllmann Michael
Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany.
Department of Anesthesiology and Intensive Care, St. Franziskus Hospital, Muenster, Germany.
Anesthesiol Res Pract. 2017;2017:7024924. doi: 10.1155/2017/7024924. Epub 2017 Jul 18.
Effects of perioperative cervical level neuraxial blocks on the dissemination of cancer metastases have become a matter of substantial interest. However, experience with these catheters has been limited and data on feasibility and efficacy is sparse.
Data from 39 patients scheduled to undergo breast cancer surgery while awake with a cervical epidural alone was retrospectively analyzed.
In 26 patients (66,7%, 95% CI 51,7-81,7) the cervical epidural catheter was sufficient for surgery. In one patient (2.6%, 95% CI 0-7.6) identification of the epidural space was not possible. Four patients (10.3%, 95% CI 0,7-19,9) had an insufficient sensory block. Seven patients (17.9%, 95% CI 5,7-30,1) had a partially insufficient sensory block. Rates of failed epidural blocks were not significantly different between different insertion levels. 21 patients (80.8%, 95% CI 65,4-96,1) developed hypotension and required an intravenous vasopressor. One patient developed nausea. In one patient the dura was accidentally punctured. No neurological damage was observed. No other major complications were observed.
Epidural punctures in the cervical region are feasible but do bear potential for major complications. Anesthesiologists should familiarize themselves with high epidural block techniques.
围手术期颈椎水平神经轴阻滞对癌症转移扩散的影响已成为备受关注的问题。然而，这些导管的使用经验有限，关于其可行性和有效性的数据也很稀少。
对39例计划在清醒状态下仅行颈椎硬膜外麻醉进行乳腺癌手术的患者的数据进行回顾性分析。
26例患者（66.7%，95%可信区间51.7 - 81.7）的颈椎硬膜外导管足以满足手术需求。1例患者（2.6%，95%可信区间0 - 7.6）无法确定硬膜外间隙。4例患者（10.3%，95%可信区间0.7 - 19.9）感觉阻滞不足。7例患者（17.9%，95%可信区间5.7 - 30.1）感觉阻滞部分不足。不同穿刺水平的硬膜外阻滞失败率无显著差异。21例患者（80.8%，95%可信区间65.4 - 96.1）出现低血压，需要静脉注射血管升压药。1例患者出现恶心。1例患者硬膜意外穿破。未观察到神经损伤。未观察到其他重大并发症。
颈椎区域的硬膜外穿刺是可行的，但确实存在发生重大并发症的可能性。麻醉医生应熟悉高位硬膜外阻滞技术。
