生理盐水注射速度对胸椎硬膜外麻醉视神经鞘直径的影响。

The Effect of Speed of Normal Saline Injection on Optic Nerve Sheath Diameter in Thoracic Epidural Anesthesia.

机构信息

Keimyung University School of Medicine Republic of Korea.

Department of Anesthesiology and Pain Medicine, Keimyung University DongSan Hospital, Dae Gu, Korea.

出版信息

Pain Physician. 2019 Jul;22(4):E325-E332.

PMID:31337174

Abstract

BACKGROUND

Intracranial pressure (ICP) is affected after epidural saline solution or local anesthetic injection. Both ICP and epidural pressures have been shown to reach peak pressure just after epidural injection and begin decline thereafter. Measuring the optic nerve sheath diameter (ONSD) through ultrasonography is one of the noninvasive methods used for ICP assessment.

OBJECTIVES

The purpose of this study was to investigate the effect of the speed of epidural saline injection on the ONSD under awake conditions.

STUDY DESIGN

Prospective randomized trial.

SETTING

An interventional pain management practice in South Korea.

METHODS

This study included 40 patients receiving thoracic epidural catheterization for pain management after upper abdominal or thoracic surgery. Following successful epidural space confirmation, patients were randomized to receive epidural saline infusion with a speed of either 1 mL/second (slow speed, A group) or 3 mL/second (rapid speed, B group), respectively. For the measurement of ONSD, transorbital sonography was performed and ONSD was measured at 3 mm posterior to the optic nerve head.

RESULTS

The A and B groups showed significant increases in ONSD according to time. Post hoc analysis of this result revealed that ONSD at T10 and T30 were significantly increased from baseline values (T0) (*P < 0.05 vs. T0; +P < 0.001 vs. T0). The mean values at any of the time points and degree of changes (T1-T0, T10-T0, and T30-T0) in ONSD between groups A and B did not show any significance.

LIMITATIONS

We could not confirm the time of normalization of ONSD after the end of epidural injection of normal saline.

CONCLUSIONS

Thoracic epidural injection of 10 mL of normal saline solution resulted in a significant increase of ONSD compared to baseline, however, the speed of injection did not affect the increase of ONSD.

KEY WORDS

Epidural, saline, optic nerve, diameter. Trial registry number: Clinical trial registry information service (NCT03362255).

摘要

背景

硬膜外生理盐水或局部麻醉剂注射后会影响颅内压（ICP）。已证明硬膜外注射后，ICP 和硬膜外压均会立即达到峰值，并随后开始下降。通过超声测量视神经鞘直径（ONSD）是评估 ICP 的非侵入性方法之一。

目的

本研究旨在探讨在清醒状态下硬膜外生理盐水注射速度对 ONSD 的影响。

研究设计

前瞻性随机试验。

地点

韩国一家介入性疼痛管理实践。

方法

本研究纳入了 40 例在上腹部或胸部手术后接受胸椎硬膜外导管置入以进行疼痛管理的患者。在成功确认硬膜外间隙后，患者被随机分为以 1 毫升/秒（慢速度，A 组）或 3 毫升/秒（快速度，B 组）的速度分别输注硬膜外生理盐水。为了测量 ONSD，进行眶间超声检查，并在视神经头后 3 毫米处测量 ONSD。

结果

A 组和 B 组的 ONSD 随时间均显著增加。对该结果进行事后分析显示，T10 和 T30 时的 ONSD 与基线值（T0）相比显著增加（*P<0.05 对比 T0；+P<0.001 对比 T0）。在任何时间点和 ONSD 变化程度（T1-T0、T10-T0 和 T30-T0）方面，A 组和 B 组之间的平均值均无显著性差异。