Kotani Taichi, Inoue Satoki, Uemura Keiko, Kawaguchi Masahiko
Department of Anesthesiology and Division of Intensive Care, Nara Medical University, 840 Shijo-cho Kashihara, Nara, 634-8522, Japan.
Department of Anesthesiology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan.
JA Clin Rep. 2021 Aug 19;7(1):64. doi: 10.1186/s40981-021-00460-w.
It has been suggested that radiating pain during spinal or epidural needle insertion and catheter placement can be an indicator of needle-related nerve injury. In this study, using a historical cohort, we investigated what factors could be associated with postoperative persistent paresthesia. In addition, we focused on radiating pain during epidural needle insertion and catheterization.
This was a retrospective review of an institutional registry containing 21,606 anesthesia cases. We conducted multivariate logistic analysis in 2736 patients, who underwent epidural anesthesia, using the incidence of postoperative persistent paresthesia as a dependent variable and other covariates, including items of the anesthesia registry and the postoperative questionnaire, as independent variables in order to investigate the factors that were significantly associated with the risk of persistent paresthesia.
One hundred and seventy-six patients (6.44%) were found to have persistent paresthesia. Multivariate analysis revealed that surgical site at the extremities (odds ratio (OR), 12.5; 95% confidence interval (CI), 2.77-56.4; the reference was set at abdominal surgery), duration of general anesthesia (per 10 min) (OR, 1.02; 95% CI, 1.01-1.03), postoperative headache (OR, 1.78; 95% CI, 1.04-2.95), and days taken to visit the consultation clinic (OR, 1.03; 95% CI, 1.01-1.06) were independently associated with persistent paresthesia. Radiating pain was not significantly associated with persistent paresthesia (OR, 1.56; 95% CI, 0.69-3.54).
Radiating pain during epidural procedure was not statistically significantly associated with persistent paresthesia, which may imply that this radiating pain worked as a warning of nerve injury.
有人提出，在脊髓或硬膜外穿刺针插入及导管置入过程中出现的放射痛可能是与穿刺针相关的神经损伤的一个指标。在本研究中，我们使用历史队列研究，调查了哪些因素可能与术后持续性感觉异常相关。此外，我们重点关注了硬膜外穿刺针插入和置管过程中的放射痛。
这是一项对包含21606例麻醉病例的机构登记册的回顾性研究。我们对2736例行硬膜外麻醉的患者进行了多因素逻辑分析，以术后持续性感觉异常的发生率作为因变量，以包括麻醉登记册项目和术后问卷调查在内的其他协变量作为自变量，以调查与持续性感觉异常风险显著相关的因素。
发现176例患者（6.44%）有持续性感觉异常。多因素分析显示，四肢手术部位（比值比（OR），12.5；95%置信区间（CI），2.77 - 56.4；以腹部手术为参照）、全身麻醉持续时间（每10分钟）（OR，1.02；95%CI，1.01 - 1.03）、术后头痛（OR，1.78；95%CI，1.04 - 2.95）以及到会诊门诊就诊的天数（OR，1.03；95%CI，1.01 - 1.06）与持续性感觉异常独立相关。放射痛与持续性感觉异常无显著相关性（OR，1.56；95%CI，0.69 - 3.54）。
硬膜外操作过程中的放射痛与持续性感觉异常在统计学上无显著相关性，这可能意味着这种放射痛起到了神经损伤预警的作用。
