Departments of Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, CCLCM of Case Western Reserve University, Cleveland, Ohio.
Department of Anesthesiology, Detroit Medical Center, Detroit, Michigan; Outcomes Research Consortium, Anesthesiology Institute, Cleveland, Ohio.
Pain Med. 2019 Sep 1;20(9):1750-1755. doi: 10.1093/pm/pnz026.
The anatomical landmarks method is currently the most widely used technique for epidural needle insertion and is faced with multiple difficulties in certain patient populations. Real-time ultrasound guidance has been recently used to aid in epidural needle insertion, with promising results. Our aim was to test the feasibility, success rate, and satisfaction associated with a novel real-time ultrasound-guided lumbar epidural needle insertion in the transverse interlaminar view.
Prospective descriptive trial on a novel approach.
Operating room and preoperative holding area at a tertiary care hospital.
Adult patients presenting for elective open prostatectomy and planned for surgical epidural anesthesia.
Consented adult patients aged 30-80 years scheduled for open prostatectomy under epidural anesthesia were enrolled. Exclusion criteria included allergy to local anesthetics, infection at the needle insertion site, coagulopathy, and patient refusal. A curvilinear low-frequency (2-5 MHz) ultrasound probe and echogenic 17-G Tuohy needles were used by one of three attending anesthesiologists. Feasibility of epidural insertion was defined as a 90% success rate within 10 minutes.
Twenty-two patients were enrolled into the trial, 14 (63.6%) of whom found the process to be satisfactory or very satisfactory. The median time to perform the block was around 4.5 minutes, with an estimated success rate of 95%. No complications related to the epidural block were observed over the 48 hours after the procedure.
We demonstrate the feasibility of a novel real-time ultrasound-guided epidural with transverse interlaminar view.
解剖标志法是目前最广泛应用于硬膜外针插入的技术，但在某些特定患者群体中面临多种困难。实时超声引导最近已被用于辅助硬膜外针插入，取得了有前景的结果。我们的目的是测试在横向椎间平面实时超声引导下进行新型腰椎硬膜外针插入的可行性、成功率和患者满意度。
一种新方法的前瞻性描述性试验。
三级保健医院的手术室和术前等候区。
接受择期开放性前列腺切除术并计划接受手术硬膜外麻醉的成年患者。
纳入年龄在 30-80 岁之间、拟行开放性前列腺切除术并接受硬膜外麻醉的成年患者。排除标准包括对局部麻醉剂过敏、穿刺部位感染、凝血障碍和患者拒绝。由三位主治麻醉师之一使用曲线低频（2-5MHz）超声探头和超声可识别的 17-G Tuohy 针。硬膜外插入的可行性定义为 10 分钟内成功率达到 90%。
共有 22 名患者入组本试验，其中 14 名（63.6%）患者对该过程表示满意或非常满意。进行阻滞的中位时间约为 4.5 分钟，估计成功率为 95%。在术后 48 小时内未观察到与硬膜外阻滞相关的并发症。
我们证明了在横向椎间平面实时超声引导下进行新型硬膜外阻滞的可行性。
