Blanco D, Llamazares J, Martínez-Mora J, Vidal F
Servicio de Anestesiologia, Reanimación y Terapia del Dolor, Hospital Universitario de Badalona Germans Trias i Pujol, Badalona, Barcelona.
Rev Esp Anestesiol Reanim. 1994 Jul-Aug;41(4):209-13.
To compare analgesic effect of bupivacaine during and after surgery when delivered through a lumbar epidural catheter entering by the caudal route with either caudal or lumbar administration of anesthetic through the needle.
One hundred forty ASA I patients under 110 months undergoing infraumbilical surgery were studied. The children were distributed randomly into 3 groups: group 1, caudal puncture and anesthesia with 2.5 mg/kg bupivacaine 1:200,000; group 2, lumbar puncture at L4-L5 and 1.25 mg/kg of the same local anesthetic; and group 3, epidural catheter in the caudal space up to L4-L5 and 1.25 mg/kg of the same local anesthetic administered through the catheter (Minipack: SYSTEM 2-Portex). The patients were anesthetized with endovenous or inhalational anesthetics. Variables recorded were analgesia during surgery (hemodynamic constants) and afterwards (CHEOPS scale), level of cutaneous sensory blockade immediately after the operation and its relationship to age, complementary analgesia used and complications. X-rays of the distal end of the catheter were taken in group 3.
Analgesia during and after surgery was sufficient for all patients in group 1. Two patients, 1 from group 2 and 1 from group 3, were eliminated due to lack of analgesia during surgery. The level of cutaneous sensory blockade attained was significantly lower in group 3 than in group 1, and only in group 1 were we able to establish a linear correlation between level of sensory blockade and age (R = 0.51; p < 0.01). In group 3, 85.5% of the catheters reached L4-L5. Complementary analgesia was similar in the three groups. Complications included 5 cases of blood loss at the point of puncture in groups 1 and 2, and 1 case of catheter penetration of the juncture in group 3.
Epidural anesthesia by way of a catheter entering by the caudal space allows us to achieve intra- and postoperative analgesia of comparable quality to that afforded by a lumbar approach or a single direct caudal puncture.
比较经骶管途径置入腰段硬膜外导管，通过导管给药与经针进行骶管或腰段麻醉时布比卡因在手术期间及术后的镇痛效果。
对140例年龄在110个月以下、美国麻醉医师协会（ASA）分级为I级、接受脐下手术的患者进行研究。将患儿随机分为3组：第1组，经骶管穿刺并使用2.5mg/kg布比卡因1:200,000进行麻醉；第2组，于L4-L5行腰椎穿刺并使用相同局部麻醉药1.25mg/kg；第3组，在骶管间隙置入硬膜外导管至L4-L5，并通过导管给予相同局部麻醉药1.25mg/kg（Minipack: SYSTEM 2-Portex）。患者采用静脉或吸入麻醉。记录的变量包括手术期间的镇痛情况（血流动力学常数）及术后情况（CHEOPS评分）、术后即刻皮肤感觉阻滞平面及其与年龄的关系、使用的辅助镇痛措施及并发症。对第3组患者的导管远端进行X线检查。
第1组所有患者手术期间及术后镇痛效果良好。第2组和第3组各有1例患者因手术期间镇痛效果不佳被排除。第3组达到的皮肤感觉阻滞平面显著低于第1组，仅在第1组中我们能够建立感觉阻滞平面与年龄之间的线性相关性（R = 0.51；p < 0.01）。在第3组中，85.5%的导管到达L4-L5。三组的辅助镇痛情况相似。并发症包括第1组和第2组各有5例穿刺点出血，第3组有1例导管穿透关节。
经骶管间隙置入导管进行硬膜外麻醉，可使我们获得与腰段途径或单次直接骶管穿刺相当的术中和术后镇痛质量。
