Department of Anaesthesiology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
West Afr J Med. 2021 Apr 23;38(4):374-379.
Localization of epidural space has no clear-cut end point like during subarachnoid block, making it an enigma to the anaesthetist. Confirmation of correct placement of the catheter is desirable in order to prevent failure, high or total spinal when large amount of local anaesthetic agent is inadvertently injected in the intrathecal space, subdural block and lastly local anaesthesia systemic toxicity. This study evaluated the use of meniscus sign to confirm correct placement of epidural catheter.
A total of 80 patient's scheduled for epidural anaesthesia were recruited into this prospective observational study. The epidural space was located using the loss of resistance to air (LORA) technique. An epidural catheter was inserted gradually through the Tuohy needle, with its removal, 4cm of catheter left in the space and a test dose of 2% lidocaine with adrenaline was instilled. The presence of meniscus sign on the catheter was used to confirm correct placement. The number of correctly placed epidural catheters, intravascular or peri-dura placements were all noted.
Of the 80 patients, meniscus sign confirmed correct epidural catheter placement in 74 of them"(92.5% success)". The study showed 100% success for both sensitivity and specificity when the meniscus sign was used for locating epidural placement.
The meniscus sign is a reliable indicator of correct epidural catheter placement, with high sensitivity and specificity.
与蛛网膜下隙阻滞不同，硬膜外腔的定位没有明确的终点，这对麻醉医师来说是一个谜。为了防止因意外将大量局部麻醉剂注入蛛网膜下腔、硬膜下腔阻滞和局部麻醉全身毒性而导致失败、高或全脊髓麻醉，需要确认导管的正确位置。本研究评估了使用半月板征来确认硬膜外导管的正确位置。
本前瞻性观察研究共纳入 80 名计划行硬膜外麻醉的患者。使用空气损失阻力（LORA）技术定位硬膜外腔。逐渐通过 Tuohy 针插入硬膜外导管，拔出时，导管在空间中留下 4cm，注入 2%利多卡因加肾上腺素的试验剂量。使用导管上半月板征来确认正确的位置。记录正确放置的硬膜外导管、血管内或硬膜外放置的数量。
在 80 名患者中，半月板征在 74 名患者中（92.5%的成功率）确认了正确的硬膜外导管放置。当使用半月板征定位硬膜外位置时，该研究显示出 100%的敏感性和特异性。
半月板征是确认硬膜外导管正确放置的可靠指标，具有高敏感性和特异性。
