Li Huili, Kang Yi, Jin Li, Ma Danxu, Liu Yang, Wang Yun
Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongtinan Road, Chaoyang District, Beijing, 100020, China.
Department of Pharmaceutical Science, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
J Anesth. 2020 Feb;34(1):29-35. doi: 10.1007/s00540-019-02704-7. Epub 2019 Oct 30.
The present study was designed to compare the feasibility of ultrasound (US)-guided lumbar epidural access using paramedian sagittal scanning (PMSS) and paramedian transverse scanning (PMTS) approaches.
Fifty patients undergoing surgery of the lower extremities were randomly allocated into 2 groups. The patients in PMSS group received PMSS-guided in-plane epidural access, whereas patients in PMTS group received PMTS-guided in-plane epidural access. The US visibility of neuraxial structures and of Tuohy needle during US scout scan, procedure duration, the number of attempts to access epidural space, Tuohy needle puncture depth in the epidural space, and extent of sensory block after spinal block between two groups were compared.
The US visibility of Tuohy needle and neuraxial structures was comparable between two groups. There was an overall decrease in procedure duration in the PMTS group relative to the PMSS group (360 ± 42 vs. 490 ± 38 s). The number of attempts needed to access the epidural space in PMSS group was significantly higher than in PMTS group. Distances between the epidural space and the puncture site in PMSS group and PMTS group showed a significant difference (7.13 ± 0.67 vs. 5.24 ± 0.21 cm). No significant differences in the extent of sensory block after spinal block were observed.
We found that PMTS approach was superior as a means of achieving epidural access relative to the PMSS approach, since PMTS approach can be conducted more quickly given shorter path of the needle and less times needed for epidural access during this procedure.
Chinese Clinical Trial Registry, clinical trial number ChiCTR1800015815, date of registration April 24, 2018.
本研究旨在比较超声（US）引导下采用旁正中矢状面扫描（PMSS）和旁正中横断面扫描（PMTS）方法进行腰椎硬膜外穿刺的可行性。
50例行下肢手术的患者被随机分为2组。PMSS组患者接受PMSS引导下的平面内硬膜外穿刺，而PMTS组患者接受PMTS引导下的平面内硬膜外穿刺。比较两组在超声预扫描时神经轴结构和Tuohy针的超声可见性、操作时间、硬膜外腔穿刺尝试次数、Tuohy针在硬膜外腔的穿刺深度以及脊麻后感觉阻滞范围。
两组Tuohy针和神经轴结构的超声可见性相当。与PMSS组相比，PMTS组的操作时间总体缩短（360±42秒对490±38秒）。PMSS组进入硬膜外腔所需的尝试次数显著高于PMTS组。PMSS组和PMTS组硬膜外腔与穿刺点之间的距离存在显著差异（7.13±0.67厘米对5.24±0.21厘米）。脊麻后感觉阻滞范围未观察到显著差异。
我们发现，相对于PMSS方法，PMTS方法作为一种实现硬膜外穿刺的手段更具优势，因为PMTS方法可通过更短的针路径和在此过程中更少的硬膜外穿刺次数更快地完成。
中国临床试验注册中心，临床试验编号ChiCTR1800015815，注册日期2018年4月24日。
