Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA -
Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA -
Minerva Anestesiol. 2019 Apr;85(4):376-383. doi: 10.23736/S0375-9393.18.13175-0. Epub 2018 Nov 22.
Labor epidural analgesia success depends on precise needle position placement within the epidural space, with reported failure rates to be as high as 32%. In this study, we describe a novel technique employing color Doppler to aid in the confirmation of the correct position of the epidural needle tip.
Retrospective evaluation of 35 patients who received labor combined spinal-epidural (CSE) with confirmation of epidural needle position with color flow Doppler (CFD) ultrasonography. Demographic data, intervertebral level of insertion and dermatome sensory level were extracted. Video and image evaluation of CFD patterns were used to confirm epidural needle tip and catheter position. CFD was used to visualize intrathecal injection of local anesthetic in two patients.
Three different color flow patterns were visualized after the loss of resistance technique: visualization of a red and blue mosaic adjacent to the posterior complex, a mosaic pattern enveloping the trajectory of the epidural needle, and a linear deeper mosaic color pattern during spinal injection in relation to the posterior complex. Identification of epidural needle tip and epidural catheter tip occurred in 77% and 37.1% of patients, respectively.
CFD is a novel and useful technique to confirm the precise position of the epidural needle tip in the context of labor analgesia. Identification of the epidural catheter with CFD is difficult despite an adequate CSE technique.
分娩时硬膜外镇痛的成功与否取决于将硬膜外针准确放置在硬膜外腔的位置，据报道其失败率高达 32%。在这项研究中，我们描述了一种使用彩色多谱勒技术来辅助确认硬膜外针尖正确位置的新方法。
对 35 名接受分娩联合脊髓-硬膜外（CSE）麻醉并使用彩色血流多谱勒（CFD）超声确认硬膜外针位置的患者进行回顾性评估。提取人口统计学数据、插入的椎间水平和皮肤感觉水平。使用 CFD 的视频和图像评估模式来确认硬膜外针尖端和导管位置。在两名患者中，CFD 用于可视化局部麻醉药的鞘内注射。
在失去阻力技术后，可观察到三种不同的彩色血流模式：在后复合体附近可见红色和蓝色马赛克，硬膜外针轨迹上可见马赛克图案，与后复合体相关的脊髓注射时可见线性较深的马赛克颜色图案。在 77%的患者中可以识别出硬膜外针尖端，在 37.1%的患者中可以识别出硬膜外导管尖端。
CFD 是一种在分娩镇痛中确认硬膜外针尖端准确位置的新的有用技术。尽管采用了适当的 CSE 技术，但仍难以识别 CFD 中的硬膜外导管。
