Ok Si Young, Ryoo Seung Hwa, Baek Young Hee, Kim Sang Ho, Kim Soon Im, Kim Sun Chong, Park Wook, Song Dan
Department of Anesthesiology and Pain Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea.
Korean J Anesthesiol. 2009 Aug;57(2):181-184. doi: 10.4097/kjae.2009.57.2.181.
Cervical epidural anesthesia (CEA) is used for pain control and surgical procedures of the head and neck or upper arm areas. However, the failure rate of CEA is reported to be high, is the failure rate being quite higher than other sites, because of the anatomical differences of the cervical spine. We hypothesized that the loss of resistance (LOR) method combined with the drip infusion method for confirmation of the cervical epidural space can reduce the failure rate. This study investigated the usefulness of the drip infusion method.
One hundred chronic renal failure patients undergoing arteriovenous bridge graft for hemodialysis at the upper arm under cervical epidural anesthesia were recruited for this study. In the cervical epidural puncture, we identified the cervical epidural space using a combination of the LOR method with the drip infusion method. After confirmation of the epidural space with LOR method, we decided it was the true epidural space when fluid dripping to the space was present. Otherwise, if fluid dripping was not present, we designated it was pseudo LOR, and we found the true epidural space using the drip infusion method only.
In all cases, the combined LOR with drip infusion method, identify the epidural space.
Combined LOR with drip infusion method is an efficacious method for the confirmation of the cervical epidural space.
颈椎硬膜外麻醉（CEA）用于头颈部或上臂区域的疼痛控制和外科手术。然而，据报道CEA的失败率很高，由于颈椎的解剖差异，其失败率比其他部位要高得多。我们假设阻力消失（LOR）法结合滴注法来确认颈椎硬膜外间隙可降低失败率。本研究调查了滴注法的有效性。
本研究招募了100例在颈椎硬膜外麻醉下进行上臂动静脉搭桥术以进行血液透析的慢性肾衰竭患者。在颈椎硬膜外穿刺中，我们使用LOR法与滴注法相结合来确定颈椎硬膜外间隙。在用LOR法确认硬膜外间隙后，当有液体滴入该间隙时，我们判定其为真正的硬膜外间隙。否则，如果没有液体滴入，我们将其指定为假LOR，并仅使用滴注法找到真正的硬膜外间隙。
在所有病例中，LOR与滴注法相结合均能确定硬膜外间隙。
LOR与滴注法相结合是确认颈椎硬膜外间隙的有效方法。
