Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan.
Department of Anesthesiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
BMC Anesthesiol. 2022 May 10;22(1):139. doi: 10.1186/s12871-022-01657-x.
Accidental dural puncture (ADP), which is a complication of epidural anesthesia, still exists and leads to worse outcomes in surgical patients. While residency training is important for epidural competency, it remains unknown whether anesthetic experience reduces ADP in surgical patients. Using an incident reporting system along with anesthetic records, this case-controlled study retrospectively investigated risk factors associated with ADP in surgical patients.
Patients who experienced ADP during epidural anesthesia who were registered in the incident reporting system of our institution between April 2012 and March 2019 were enrolled. Patients with ADP were control-matched with those who without ADP in a 1:3 ratio, to compare the potential risk factors and calculated odds ratios (ORs) for ADP. The primary hypothesis was that anesthesiologists' experience reduces the incidence of ADP. The secondary hypothesis was that there are risk factors for ADP. Between-group differences in anesthesiologists' experience were compared using the Mann-Whitney U test. Significance was set at P < 0.05.
Thirty-five patients who experienced ADP were identified from the incident reporting system. These were matched with 69 patients who did not experience ADP. There was no difference in the years of experience of anesthesiologists between the groups that did and did not experience ADP (8 [3-20] vs. 9 [3-18] years, respectively; P = 0.65).
Having an experienced anesthesiologist did not guarantee the prevention of ADP. Daily individual training and briefings would be needed to reduce the incidence of ADP.
硬膜外麻醉的并发症——意外硬脊膜穿刺（ADP）仍然存在，并导致手术患者的结局恶化。住院医师培训对于硬膜外麻醉能力的培养很重要，但尚不清楚麻醉经验是否会降低手术患者的 ADP 发生率。本病例对照研究通过使用事件报告系统和麻醉记录，回顾性调查了与手术患者 ADP 相关的危险因素。
纳入在我们机构的事件报告系统中登记的在硬膜外麻醉期间发生 ADP 的患者。将发生 ADP 的患者与未发生 ADP 的患者按照 1:3 的比例进行病例对照匹配，以比较潜在的危险因素和 ADP 的计算比值比（OR）。主要假设是麻醉师的经验降低 ADP 的发生率。次要假设是存在 ADP 的危险因素。使用 Mann-Whitney U 检验比较两组麻醉师经验的差异。组间差异有统计学意义的标准为 P<0.05。
从事件报告系统中确定了 35 例发生 ADP 的患者，将其与 69 例未发生 ADP 的患者进行匹配。发生 ADP 组和未发生 ADP 组的麻醉师经验年限无差异（分别为 8 [3-20]年和 9 [3-18]年；P=0.65）。
有经验的麻醉师并不能保证预防 ADP 的发生。需要进行日常的个体培训和情况介绍，以降低 ADP 的发生率。
