Department of Anesthesiology, Sapporo Medical University School of Medicine, 291, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
J Anesth. 2022 Dec;36(6):693-697. doi: 10.1007/s00540-022-03096-x. Epub 2022 Aug 27.
The aim of this study was to assess the usefulness and accuracy of a handheld ultrasound device (Accuro, Rivanna Medical, Charlottesville, VA, USA) for epidural landmark and depth assessment when epidural anesthesia is performed by residents.
Patients scheduled to receive epidural anesthesia were randomly assigned to the Accuro group (group A) or control group (group C). In group A, the depth to the epidural space and the appropriate place for epidural insertion according to Accuro was recorded. In group C, epidural anesthesia was performed using a conventional method. The following were recorded and compared between the groups: time from puncture of the Tuohy needle to loss of resistance, number of Tuohy needle redirects, and epidural-related complications. In group A, depth to the epidural space estimated by Accuro (Accuro Depth) and the actual depth measured with a marker on the needle (Needle Depth) were recorded and compared.
Sixty patients were enrolled during the study period. There was no significant difference between the groups regarding the median or range of time required to locate the epidural space. The number of Tuohy needle redirects was 0 (0-3) in group A and 1.5 (0-7) in group C (P = 0.012). Accuro Depth was less than Needle Depth [mean difference, 0.85 cm (95% CI-1.10 to - 0.62), SD = 0.62].
Although there was no significant difference in time from Tuohy needle puncture to loss of resistance, Accuro reduced the number of Tuohy needle redirects and accurately indicated the depth to the epidural space. Accuro may be useful for identifying the needle insertion point and estimating depth to the epidural space when residents perform epidural anesthesia.
本研究旨在评估 Accuro 手持式超声设备（美国弗吉尼亚州夏洛茨维尔 Rivanna Medical 公司）在住院医师行硬膜外麻醉时进行硬膜外标志和深度评估的有用性和准确性。
计划接受硬膜外麻醉的患者被随机分配到 Accuro 组（A 组）或对照组（C 组）。在 A 组中，记录到达硬膜外间隙的深度和根据 Accuro 确定的硬膜外插入的适当位置。在 C 组中，使用传统方法进行硬膜外麻醉。记录并比较两组之间的以下内容：从 Tuohy 针穿刺到失去阻力的时间、Tuohy 针重定向的次数以及与硬膜外相关的并发症。在 A 组中，记录并比较 Accuro 估计的硬膜外空间深度（Accuro Depth）和针上标记测量的实际深度（Needle Depth）。
在研究期间，共纳入 60 例患者。两组到达硬膜外间隙所需的中位数或范围时间无显著差异。A 组的 Tuohy 针重定向次数为 0（0-3），C 组为 1.5（0-7）（P=0.012）。Accuro Depth 小于 Needle Depth [平均差值，0.85 cm（95%CI-1.10 至-0.62），SD=0.62]。
尽管从 Tuohy 针穿刺到失去阻力的时间无显著差异，但 Accuro 减少了 Tuohy 针重定向的次数，并准确指示了硬膜外间隙的深度。当住院医师行硬膜外麻醉时，Accuro 可能有助于确定针插入点并估计硬膜外间隙的深度。
