Cantürk Mehmet, Kocaoğlu Nazan, Hakkı Meltem
Department of Anaesthesiology and Reanimation, Kırşehir Ahi Evran University Training and Research Hospital, Kırşehir, Turkey.
Department of Anaesthesiology and Reanimation, Balıkesir University School of Medicine, Balıkesir, Turkey.
Turk J Anaesthesiol Reanim. 2020 Feb;48(1):31-37. doi: 10.5152/TJAR.2019.92342. Epub 2019 Sep 24.
The aim of this study was to assess the accuracy and precision of the actual epidural depth (ND) and ultrasound (US) estimates of the distance from the skin to the epidural space in the transverse median plane (ED/TM) and paramedian sagittal oblique plane (ED/PSO) in patients who were not pregnant and who were undergoing unilateral inguinal hernia repair surgery under combined spinal epidural anaesthesia.
A total of 100 patients with the American Society of Anaesthesiology status I-III of either gender were recruited. All epidurals were inserted at the L3-4 intervertebral space, and the epidural needle was marked with a sterile marker. The ND was measured between the marker and the tip of the needle. The ED/TM and ED/PSO were assessed with a 2-5 MHz curved array probe at the L3-4 intervertebral space. The Pearson correlation coefficient and Lin's concordance correlation coefficient were used to assess the precision and the Bland-Altman test was used to assess the 95% limit of agreement.
The ND was 48.98±6.91 mm, the ED/PSO was 48.92±6.91 mm and the ED/TM was 48.90±6.91 mm. The Pearson correlation coefficient between ND and ED/PSO was 0.995 (p<0.001) and 0.994 (p<0.001) with ED/TM. Lin's concordance correlation coefficient for ND and ED/PSO was 0.995 (95%CI [confidence interval]: 0.992-0.997), and 0.993 for ND and ED/TM (95% CI: 0.990-0.996). The 95% limit of agreement between ND and ED/PSO was 0.70-1.37, and for ND and ED/TM, it was 0.79-1.54.
Preprocedural ultrasound (US) scanning in both planes provides reliable estimates for actual epidural depth in non-pregnant patient population.
本研究旨在评估非妊娠患者在腰麻-硬膜外联合麻醉下行单侧腹股沟疝修补手术时，在横向正中平面（ED/TM）和旁正中矢状斜平面（ED/PSO）上，实际硬膜外深度（ND）以及超声（US）测量的从皮肤到硬膜外间隙距离的准确性和精确性。
共招募了100例美国麻醉医师协会分级为I-III级的患者，男女不限。所有硬膜外穿刺均在L3-4椎间隙进行，硬膜外针用无菌标记物标记。测量标记物与针尖之间的ND。在L3-4椎间隙用2-5MHz的弯阵探头评估ED/TM和ED/PSO。采用Pearson相关系数和Lin一致性相关系数评估精确性，采用Bland-Altman检验评估95%一致性界限。
ND为48.98±6.91mm，ED/PSO为48.92±6.91mm，ED/TM为48.90±6.91mm。ND与ED/PSO之间的Pearson相关系数为0.995（p<0.001），与ED/TM之间的Pearson相关系数为0.994（p<0.001）。ND与ED/PSO的Lin一致性相关系数为0.995（95%CI[置信区间]：0.992-0.997），ND与ED/TM的Lin一致性相关系数为0.993（95%CI：0.990-0.996）。ND与ED/PSO之间的95%一致性界限为0.70-1.37，ND与ED/TM之间的95%一致性界限为0.79-1.54。
术前在两个平面进行超声扫描可为非妊娠患者群体的实际硬膜外深度提供可靠估计。
