Du Joanne, Roth Catherine, Dontukurthy Sujana, Tobias Joseph D, Veneziano Giorgio
The Ohio State University College of Medicine, Columbus, OH, USA.
Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
J Pain Res. 2023 Jan 10;16:93-99. doi: 10.2147/JPR.S392438. eCollection 2023.
Awake spinal anesthesia continues as an alternative to general anesthesia for infants. Standard clinical practice includes the manual palpation of surface landmarks to identify the desired intervertebral space for lumbar puncture (LP). The current study investigates the accuracy of manual palpation for identifying the intended intervertebral site for LP, using ultrasonography for confirmation and to determine the interspace where the ends.
After informed parental consent, patients less than one year of age undergoing spinal anesthesia for lower abdominal, urologic, or lower extremity surgical procedures were included. Patients were held in the seated position and an attending pediatric anesthesiologist or pediatric anesthesiology fellow declared the vertebral interspace intended for needle insertion, palpated surface landmarks, and placed a mark at the site. A research anesthesiologist then determined the actual vertebral interspace of the marked site and the location of the using ultrasonography. The time to complete both techniques (manual palpation and ultrasonography) was recorded.
The study cohort included 50 infants (median age of 7 months). Sixteen vertebral interspaces (32%) were inaccurately marked. One was marked two spaces higher than intended, ten were marked one space higher than intended, and five were marked one space lower than intended. In one patient, the intended vertebral interspace for the lumbar puncture overlaid the . The median time required was 25 seconds (IQR 14.3, 32) for palpation and 39 seconds (IQR 29, 63.8) for ultrasonography.
Manual palpation of surface landmarks to determine the correct interspace for LP for spinal anesthesia in infants is inaccurate. The time required to perform spinal ultrasonography in infants for determination of the optimal site for LP is brief and may be useful in ensuring accurate identification of the correct interspace and the location of the .
清醒脊髓麻醉仍是婴儿全身麻醉的一种替代方法。标准临床实践包括手动触诊体表标志以确定腰椎穿刺（LP）所需的椎间隙。本研究使用超声检查进行确认并确定终丝所在间隙，以调查手动触诊确定LP预期椎间隙的准确性。
在获得家长知情同意后，纳入年龄小于1岁、因下腹部、泌尿外科或下肢外科手术接受脊髓麻醉的患者。患者取坐位，主治儿科麻醉医师或儿科麻醉专科住院医师宣布拟穿刺的椎间隙，触诊体表标志并在该部位做标记。然后，研究麻醉医师使用超声检查确定标记部位的实际椎间隙和终丝位置。记录完成两种技术（手动触诊和超声检查）所需的时间。
研究队列包括50例婴儿（中位年龄7个月）。16个椎间隙（32%）标记错误。1个标记比预期高两个间隙，10个标记比预期高一个间隙，5个标记比预期低一个间隙。1例患者中，腰椎穿刺预期的椎间隙与终丝重叠。触诊的中位时间为25秒（四分位间距14.3，32），超声检查为39秒（四分位间距29，63.8）。
手动触诊体表标志以确定婴儿脊髓麻醉LP的正确间隙不准确。婴儿进行脊髓超声检查以确定LP最佳部位所需时间短暂，可能有助于确保准确识别正确间隙和终丝位置。
