Segal S, Eappen S, Datta S
Department of Anaesthesia, Harvard Medical School, Boston, MA, USA.
J Clin Anesth. 1997 Mar;9(2):109-12. doi: 10.1016/S0952-8180(97)00232-8.
To investigate whether a change from a single-orifice to multi-orifice catheter could reduce the incidence of inadequate epidural blocks requiring replacement of the epidural catheter in obstetric patients.
Prospective before-after cohort study.
Obstetric unit at a university hospital.
872 patients requesting epidural analgesia for vaginal delivery or cesarean section.
Patients received epidural analgesia via single-orifice (n = 433) or multi-orifice (n = 439) epidural catheters, depending on the month of the trial.
Patient characteristics, obstetric procedure, anesthesiologist characteristics, and details of epidural placement did not differ significantly between the groups. The overall replacement rate was 14.3% in the single-orifice group versus 9.3% in the multi-orifice group (p = 0.032). There were no difference in the frequency of replacement for subarachnoid placement or migration, immediate intravascular placement, vascular migration, or absence of any block. Significantly fewer catheters were replaced in the multi-orifice group for inadequate analgesia, defined as unblocked segments or unilateral block (6.4% vs. 2.8%, p = 0.018). Paresthesias were less common in the multi-orifice group (22.4% vs. 31.5%, p = 0.003). There were no unrecognized subarachnoid or vascular catheter placements in either group.
The multi-orifice design offers significant advantages over the single-orifice type for obstetricepidural analgesia.
探讨从单孔导管改为多孔导管是否能降低产科患者中因硬膜外阻滞效果不佳而需要更换硬膜外导管的发生率。
前瞻性前后队列研究。
一所大学医院的产科病房。
872例因阴道分娩或剖宫产而要求硬膜外镇痛的患者。
根据试验月份，患者通过单孔硬膜外导管（n = 433）或多孔硬膜外导管（n = 439）接受硬膜外镇痛。
两组患者的特征、产科手术、麻醉医生特征以及硬膜外穿刺的细节无显著差异。单孔导管组的总体更换率为14.3%，而多孔导管组为9.3%（p = 0.032）。在蛛网膜下腔置管或移位、即刻血管内置管、血管移位或无任何阻滞的情况下，两组的更换频率无差异。对于定义为阻滞节段不全或单侧阻滞的镇痛不足情况，多孔导管组更换的导管明显更少（6.4%对2.8%，p = 0.018）。多孔导管组感觉异常较少见（22.4%对31.5%，p = 0.003）。两组均未出现未识别的蛛网膜下腔或血管内导管置管情况。
对于产科硬膜外镇痛，多孔设计比单孔设计具有显著优势。
