Verkooijen Julie, Coppejans Hilde, Mertens Els, Saldien Vera, Vercauteren Marcel
Antwerp University Hospital, Department of Anaesthesia, Edegem, Belgium.
Rom J Anaesth Intensive Care. 2017 Oct;24(2):107-110. doi: 10.21454/rjaic.7518.242.ver.
There is some evidence that anaesthetists often perform neuraxial blocks at a higher lumbar interspace than intended. It may be questioned whether parturients are at greater risk for neurological damage when the dura is perforated at a more cephalad interspace than L2-L3.
Thirty-six patients scheduled for elective Caesarean delivery under CSE anaesthesia were selected for study. Using a B-D Durasafe Adjustable needle combination, the skin-to-epidural distance and the width of the epidural space were measured and matched with 36 female patients undergoing the same anaesthetic technique for orthopaedic procedures.
Pregnant patients had a higher bodyweight (77 vs. 67 kg, p = 0.007) than those scheduled for orthopaedic surgery. The skin-to-epidural distance was similar in both groups (5.3 vs. 5.1 cm, p = 0.3). The width of the epidural space was 1.1 mm larger in parturients (8.2 vs. 7.1 mm, p = 0.04). More patients in this group had tip-to-tip distances exceeding 10 mm (25 vs. 12%).
The greater epidural space or tip-to-tip distance between the epidural and spinal needle points in term parturients results in a lower margin of safety with respect to the distance from the dura to spinal cord or conus medullaris. Puncturing the correct interspace is, therefore, of crucial importance in pregnant patients.
有证据表明，麻醉医生进行腰段神经阻滞时，穿刺间隙常高于预期。当硬膜在高于L2 - L3的头侧间隙被刺破时，产妇发生神经损伤的风险是否更高，这可能值得质疑。
选择36例计划在腰麻 - 硬膜外联合麻醉下行择期剖宫产的患者进行研究。使用B - D Durasafe可调式穿刺针组合，测量皮肤至硬膜的距离和硬膜外间隙宽度，并与36例接受相同麻醉技术的骨科手术女性患者进行对比。
孕妇体重高于骨科手术患者（77 vs. 67 kg，p = 0.007）。两组的皮肤至硬膜距离相似（5.3 vs. 5.1 cm，p = 0.3）。产妇的硬膜外间隙宽度大1.1 mm（8.2 vs. 7.1 mm，p = 0.04）。该组中更多患者的针尖间距超过10 mm（25% vs. 12%）。
足月产妇硬膜外间隙或硬膜与脊针针尖之间的针尖间距更大，导致从硬膜到脊髓或脊髓圆锥的距离安全边际降低。因此，在孕妇中穿刺到正确的间隙至关重要。
