Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
Can J Anaesth. 2019 Apr;66(4):380-387. doi: 10.1007/s12630-019-01301-2. Epub 2019 Feb 6.
This study examined the concordance between epidural electrical stimulation test (EEST) and local anesthetic (LA) test dose to indicate correct thoracic epidural catheter position. The relationship between the test results and epidural postoperative analgesia was also assessed.
This prospective observational cohort study was done in patients receiving thoracic epidural analgesia for abdominal surgery. After insertion, the epidural catheter was tested using a nerve stimulator to elicit a motor response. The LA test dose was then administered, and sensory block to ice and pinprick was assessed. The primary outcome was the presence/absence of motor response to EEST and sensory block to test dose. Concordance of responses was assessed using kappa statistics, and their predictive power of postoperative epidural analgesia was evaluated.
Sixty-eight thoracic epidural catheters were inserted, of which 62 were used perioperatively. The kappa agreement between EEST and LA test dose responses was moderate at 0.42 (95% confidence interval [CI], 0.18 to 0.67). Positive responses to EEST and LA test dose were observed in 62 (100%) and 50 (81%) patients, respectively, while 52 patients (84%) showed adequate analgesia postoperatively. The sensitivity (95% CI) of EEST and LA test dose to predict adequate postoperative epidural analgesia was 1 (0.93 to 1) and 0.79 (0.65 to 0.89), respectively, and the positive predictive values (95% CI) of EEST and LA test dose were 0.84 (0.75 to 0.93) and 0.82 (0.71 to 0.92), respectively.
Following thoracic epidural catheter insertion, the responses to the EEST and LA test dose showed "moderate" agreement. The EEST has a higher sensitivity than the LA test dose to predict adequate epidural analgesia following abdominal surgery, however, both tests have a comparable positive predictive value.
本研究旨在探讨硬膜外电刺激试验（EEST）与局部麻醉药（LA）试验剂量之间的一致性，以确定正确的胸硬膜外导管位置。还评估了测试结果与硬膜外术后镇痛之间的关系。
这是一项在接受腹部手术硬膜外镇痛的患者中进行的前瞻性观察队列研究。硬膜外导管插入后，使用神经刺激器进行测试以引出运动反应。然后给予 LA 试验剂量，并评估对冰和刺痛的感觉阻滞。主要结局是 EEST 是否存在运动反应以及试验剂量是否存在感觉阻滞。使用 Kappa 统计评估反应的一致性，并评估其对术后硬膜外镇痛的预测能力。
共插入 68 根胸硬膜外导管，其中 62 根在围手术期使用。EEST 和 LA 试验剂量反应之间的 Kappa 一致性为中度，为 0.42（95%置信区间 [CI]，0.18 至 0.67）。EEST 和 LA 试验剂量的阳性反应分别在 62 名（100%）和 50 名（81%）患者中观察到，而 52 名（84%）患者术后有足够的镇痛效果。EEST 和 LA 试验剂量预测术后硬膜外镇痛充足的敏感性（95%CI）分别为 1（0.93 至 1）和 0.79（0.65 至 0.89），EEST 和 LA 试验剂量的阳性预测值（95%CI）分别为 0.84（0.75 至 0.93）和 0.82（0.71 至 0.92）。
在插入胸硬膜外导管后，EEST 和 LA 试验剂量的反应显示出“中度”一致性。EEST 比 LA 试验剂量更能预测腹部手术后硬膜外镇痛的充足性，但两种试验的阳性预测值相当。
