Riopelle James, Gayle Julie, Anwar Zubaer, Burton Jeff
Department of Anesthesiology, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA.
Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA.
Ochsner J. 2025 Fall;25(3):187-195. doi: 10.31486/toj.24.0133.
Reported rates of unintended dural puncture during performance of continuous epidural anesthesia (CEA) or combined spinal-epidural anesthesia (CSEA) have remained steady at approximately 0.5% to 1% since the 1970s.
A modified method of inserting the Tuohy epidural catheterization needle was used during performance of CSEA in 393 parturients. A single staff/faculty anesthesiologist performed or supervised resident use of a flush-measure-check-advance Tuohy needle insertion algorithm.
The rate of evident Tuohy needle dural puncture during the series was 0%. One parturient experienced a post-dural puncture headache possibly because of intentional subarachnoid puncture with a very small diameter (25 gauge) needle during 2 CSEAs. In 19 parturients, the initial spinal anesthesia portion of CSEA failed, prompting conversion to CEA in 18 parturients and to spinal anesthesia in 1 parturient.
The use of a flush-measure-check-advance Tuohy needle insertion algorithm to reduce the likelihood of unintended dural puncture during performance of CSEA in parturients deserves further study.
自20世纪70年代以来，连续硬膜外麻醉（CEA）或腰麻-硬膜外联合麻醉（CSEA）过程中意外硬膜穿破的报告发生率一直稳定在约0.5%至1%。
在393例产妇行CSEA期间，采用改良的Tuohy硬膜外导管穿刺针插入方法。由一名麻醉科工作人员/教员实施或监督住院医师使用冲洗-测量-检查-推进Tuohy针插入算法。
该系列中明显的Tuohy针硬膜穿破率为0%。一名产妇出现了硬膜穿破后头痛，可能是因为在两次CSEA期间故意用非常细（25G）的针进行蛛网膜下腔穿刺。在19例产妇中，CSEA的初始腰麻部分失败，促使18例产妇转为CEA，1例产妇转为腰麻。
使用冲洗-测量-检查-推进Tuohy针插入算法以降低产妇行CSEA期间意外硬膜穿破的可能性值得进一步研究。
