McNeely J K, Trentadue N C, Rusy L M, Farber N E
Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, USA.
Reg Anesth. 1997 Sep-Oct;22(5):428-31. doi: 10.1016/s1098-7339(97)80028-4.
Continuous epidural analgesia has been used with increasing frequency to provide postoperative pain relief for children. Epidural space infection is a potential complication of epidural catheter placement. This study investigated the incidence of bacterial colonization on lumbar and caudal epidural catheter tips in postoperative pediatric patients.
In this prospective study, lumbar and caudal epidural catheters were placed in the operating room with aseptic technique. Dilute local anesthetic and/or opioid infusions were used for postoperative analgesia. On discontinuation of the epidural infusion, the skin site was decontaminated with 70% alcohol and then cultured. The distal catheter tip and hub were cultured. Semiquantitative and qualitative aerobic cultures were performed.
Data from 91 epidural catheters were available (45 caudal versus 46 lumbar). Of the 45 caudal catheter tips 9 (20%) were colonized, compared with 2 of the 46 (4%) lumbar catheter tips (P < .02). Staphylococcus epidermidis was the predominant skin and catheter tip organism isolated in both groups. Four of nine caudal catheter tips grew gram-negative bacteria. Statistical analyses did not show that time, skin site inflammation, or dressing condition were independent predictors of catheter tip colonization. No patient developed a clinical epidural infection during the study period.
The results of this study suggest that the risk of clinical epidural infection associated with caudal or lumbar postoperative catheters is low. However, the incidence of epidural catheter tip colonization is increased with the caudal route of insertion, and the bacteria differ from those cultured from the lumbar insertion site.
连续硬膜外镇痛越来越多地用于为儿童提供术后疼痛缓解。硬膜外腔感染是硬膜外导管置入的潜在并发症。本研究调查了小儿术后患者腰段和骶管硬膜外导管尖端细菌定植的发生率。
在这项前瞻性研究中，在手术室采用无菌技术放置腰段和骶管硬膜外导管。使用稀释的局麻药和/或阿片类药物输注进行术后镇痛。在停止硬膜外输注时，用70%酒精对皮肤部位进行消毒，然后进行培养。对导管远端尖端和接头进行培养。进行半定量和定性需氧培养。
可获得91根硬膜外导管的数据（45根骶管导管与46根腰段导管）。45根骶管导管尖端中有9根（20%）被定植，而46根腰段导管尖端中有2根（4%）被定植（P<0.02）。表皮葡萄球菌是两组中分离出的主要皮肤和导管尖端微生物。9根骶管导管尖端中有4根培养出革兰氏阴性菌。统计分析未显示时间、皮肤部位炎症或敷料情况是导管尖端定植的独立预测因素。在研究期间，没有患者发生临床硬膜外感染。
本研究结果表明，与骶管或腰段术后导管相关的临床硬膜外感染风险较低。然而，骶管插入途径会增加硬膜外导管尖端定植的发生率，且所培养的细菌与腰段插入部位的不同。
