Yakhup Adila, Okada Hisako, Kawagoe Izumi, Sumikura Hiroyuki
Department of Anesthesiology and Pain Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan.
Department of Anesthesiology and Pain Medicine, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-Ku, Tokyo, 177-8521, Japan.
JA Clin Rep. 2023 Aug 30;9(1):56. doi: 10.1186/s40981-023-00648-2.
Neuraxial anesthesia is widely used as the most effective and standard method in obstetric anesthesia. However, there is a concern that neuraxial anesthesia may be technically difficult or ineffective in pregnant women with spinal disease. Therefore, this study aimed to investigate the implementation rate of neuraxial anesthesia among pregnant women with spinal diseases and their success rate at our institution.
The subjects of this study were pregnant patients who delivered at Juntendo University Nerima Hospital between April 2017 and December 2020. After obtaining ethics committee approval, data were collected from patients' medical records.
Of the 2682 pregnant women who delivered, 1550 underwent preanesthetic evaluation. There were 42 deliveries in 39 pregnant women with spinal diseases (1.7% of all pregnant women and 2.7% of those who underwent preanesthetic evaluation). The diagnoses included adolescent idiopathic scoliosis (51.3%), lumbar disc herniation (23.1%), and others. The mode of delivery was the elective cesarean section in 5 cases, emergent cesarean section in 8 cases, and vaginal delivery in 29 cases. Only one case required general anesthesia. Of the 38 cases of labor analgesia, the neuraxial block was inadequate in 3 cases (7.9%) and technically difficult in 3 cases (7.9%). However, the patients complained of no lower extremity neuropathy, infection, or inadvertent dural puncture.
Neuraxial anesthesia was an option in most cases, even in pregnant women complicated with spinal disease, if an anesthesiologist's plan before delivery after careful preanesthetic evaluation.
椎管内麻醉是产科麻醉中广泛使用的最有效和标准的方法。然而，有人担心椎管内麻醉在患有脊柱疾病的孕妇中可能技术上困难或无效。因此，本研究旨在调查我院患有脊柱疾病的孕妇中椎管内麻醉的实施率及其成功率。
本研究的对象是2017年4月至2020年12月在顺天堂大学练马医院分娩的孕妇。在获得伦理委员会批准后，从患者病历中收集数据。
在2682名分娩的孕妇中，1550名接受了麻醉前评估。39名患有脊柱疾病的孕妇中有42例分娩（占所有孕妇的1.7%，占接受麻醉前评估孕妇的2.7%）。诊断包括青少年特发性脊柱侧凸（51.3%）、腰椎间盘突出症（23.1%）等。分娩方式为择期剖宫产5例，急诊剖宫产8例，阴道分娩29例。仅1例需要全身麻醉。在38例分娩镇痛病例中，3例（7.9%）椎管内阻滞效果不佳，3例（7.9%）技术上困难。然而，患者未抱怨有下肢神经病变、感染或意外硬膜穿破。
即使在合并脊柱疾病的孕妇中，在仔细的麻醉前评估后，如果麻醉医生在分娩前制定了计划，椎管内麻醉在大多数情况下也是一种选择。
