Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seodaemun-gu, Korea (the Republic of).
Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seodaemun-gu, Korea (the Republic of)
Reg Anesth Pain Med. 2024 Jan 11;49(1):17-22. doi: 10.1136/rapm-2023-104504.
Intravascular injection of a local anesthetic can lead to life-threatening complications, such as deficits in neurological function after caudal epidural block. This study aimed to determine whether the intravascular injection rate of the Tuohy needle is lower than that of the Quincke needle during an ultrasound-guided caudal block.
Two-hundred and thirty patients were randomized into the Quincke (n=115) and the Tuohy (n=115) needle groups. The randomly selected needle was introduced at a 45° angle until it penetrated the sacrococcygeal ligament under ultrasound guidance, and intravenous injections were analyzed using contrast-dyed digital subtraction angiography. The relationship between the incidence of intravascular injection and independent variables, including needle type, patient demographics, history of lumbosacral surgery, use of anticoagulants, anatomic variables of the sacrum, presence of bony contact during the procedure, and the number of needle repositioning under ultrasound guidance, were examined.
Intravascular uptake of contrast medium was surveyed in 25/230 (10.9%) caudal blocks using digital subtraction angiography (DSA). The incidence of intravascular uptake was 13.9% (16/115) using the Quincke needle and 7.8% (9/115) using the Tuohy needle (p=0.14). Although the needle tip type was not associated with the rate of intravascular injection, the occurrence of bony contact during the procedure demonstrated a relationship with the intravenous injection (p<0.01).
The overall incidence of inadvertent intravascular injections during ultrasound-guided caudal block confirmed using DSA was 10.9%. Tuohy needles did not reduce intravascular injection rates during the ultrasound-guided caudal block.
NCT05504590.
局部麻醉药的血管内注射可导致危及生命的并发症，例如在骶尾部硬膜外阻滞后出现神经功能缺陷。本研究旨在确定在超声引导下骶尾部阻滞时，Tuohy 针的血管内注射率是否低于 Quincke 针。
将 230 例患者随机分为 Quincke 针（n=115）和 Tuohy 针（n=115）组。在超声引导下，以 45°角进针，直至穿透尾骨尾骨韧带，使用对比染料数字减影血管造影分析静脉注射。分析了针型、患者人口统计学特征、腰骶部手术史、抗凝药物使用、骶骨解剖学特征、手术过程中是否存在骨接触以及在超声引导下重新定位针的次数等独立变量与血管内注射发生率之间的关系。
通过数字减影血管造影（DSA）调查了 230 例骶尾部阻滞中 25 例（10.9%）的血管内造影剂摄取情况。Quincke 针的血管内摄取发生率为 13.9%（16/115），Tuohy 针为 7.8%（9/115）（p=0.14）。尽管针尖类型与血管内注射率无关，但手术过程中出现骨接触与静脉注射有关（p<0.01）。
使用 DSA 确认，超声引导下骶尾部阻滞时意外血管内注射的总发生率为 10.9%。Tuohy 针在超声引导下骶尾部阻滞时并未降低血管内注射率。
NCT05504590。
