超声引导下经针置管法在成人骶管硬膜外导管置入中的应用：技术要点
Ultrasonography-guided catheter-over-needle insertion for caudal epidural catheter placement in adults: technical considerations.
作者信息
Zhang Pei, Chen Hongzhou, Yu Keqiang, Ran Xia, Wang Rurong, Wu Jing
机构信息
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
Institute of Integrated Traditional Chinese and Westen Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
出版信息
BMC Anesthesiol. 2025 Apr 1;25(1):149. doi: 10.1186/s12871-025-02889-3.
BACKGROUND
Caudal epidural analgesia significantly reduces acute pain after anorectal surgery; however, caudal epidural catheter placement (CECP) remains challenging, and the safety of real-time ultrasonography-guided CECP is uncertain. This study aimed to evaluate the success rate and related complications of real-time ultrasonography-guided CECP and describe the technical considerations.
METHODS
This prospective, single-center observational study included 233 patients catheterized in the left lateral decubitus position. The sacral hiatus was palpated and then confirmed using ultrasonography. A catheter-over-needle was inserted through the sacrococcygeal ligament under real-time ultrasonographic guidance, the metallic needle was withdrawn through the outer sleeve, and the epidural catheter was placed through the outer sleeve into the sacral canal epidural space. The primary outcome was the success rate of CECP; several surgical variables, the incidence of related complications, and improvement measures were also assessed.
RESULTS
CECP through the sacral hiatus was successful in 231 patients. The sacral canal depth at the hiatus apex, the mean distance between the sacral cornua, and the distance from the skin to the inferior margin of the sacrococcygeal ligament were 5.07 ± 1.38, 8.00 ± 1.94, and 14.24 ± 4.18 mm, respectively. The sacral canal depth was > 3 mm in 94.4% of patients. No complications, such as epidural hematoma, dura puncture, and intraspinal infection during postoperative epidural catheter utilization, occurred.
CONCLUSION
Ultrasonography-guided CECP through the sacral hiatus is a simple, feasible, safe, and effective technique for postoperative anorectal analgesia. Additionally, caudal epidural analgesia manages severe pain after anorectal surgery. Therefore, this technology merits comprehensive clinical application.
TRIAL REGISTRATION NUMBER
No. ChiCTR 2,000,038,918.
背景
骶管硬膜外镇痛可显著减轻肛肠手术后的急性疼痛；然而，骶管硬膜外导管置入（CECP）仍具有挑战性，且实时超声引导下CECP的安全性尚不确定。本研究旨在评估实时超声引导下CECP的成功率及相关并发症，并描述技术要点。
方法
这项前瞻性、单中心观察性研究纳入了233例左侧卧位置管的患者。触诊骶裂孔，然后用超声进行确认。在实时超声引导下，将套管针经骶尾韧带插入，将金属针通过外套管抽出，再将硬膜外导管通过外套管置入骶管硬膜外间隙。主要结局是CECP的成功率；还评估了几个手术变量、相关并发症的发生率及改进措施。
结果
231例患者经骶裂孔成功完成CECP。骶裂孔顶点处的骶管深度、骶角之间的平均距离以及皮肤至骶尾韧带下缘的距离分别为5.07±1.38、8.00±1.94和14.24±4.18mm。94.4%的患者骶管深度>3mm。术后硬膜外导管使用期间未发生硬膜外血肿、硬膜穿刺和椎管内感染等并发症。
结论
超声引导下经骶裂孔进行CECP是一种用于肛肠术后镇痛的简单、可行、安全且有效的技术。此外，骶管硬膜外镇痛可有效管理肛肠手术后的剧痛。因此，这项技术值得在临床全面应用。
试验注册号
ChiCTR 2,000,038,918。
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