Huffnagle S L, Norris M C, Arkoosh V A, Huffnagle H J, Ferouz F, Boxer L, Leighton B L
Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Anesth Analg. 1998 Aug;87(2):326-30. doi: 10.1097/00000539-199808000-00017.
Both asymmetrical sensory blockade and dural puncture are undesirable outcomes of epidural analgesia. Identifying the epidural space with the needle bevel oriented parallel to the longitudinal axis of the patient's back limits the risk of headache in the event of dural puncture. However, rotating the bevel to direct a catheter cephalad may risk dural puncture. We prospectively studied the effects of needle rotation on the success of labor epidural analgesia and on the incidence of dural puncture. One hundred sixty ASA physical status I or II laboring parturients were randomly assigned to one of four groups. The epidural space was identified with the bevel of an 18-gauge Hustead needle directed to the patient's left. It was then rotated as follows: Group 0 = no rotation, final bevel orientation left (n = 39); Group 90 = rotation 90 degrees clockwise, bevel cephalad (n = 43); Group 180 = rotation 180 degrees clockwise, bevel right (n = 36); Group 270 = rotation 270 degrees clockwise, bevel caudad (n = 42). A single-orifice catheter was inserted 3 cm, and analgesia was induced in a standardized fashion. Dural puncture was evenly distributed among the groups (4.4%). There were more dermatomal segments blocked, fewer one-sided blocks, and more patients comfortable at 30 min with the needle bevel directed cephalad. Using a catheter inserted through a needle oriented in the cephalad direction increases the success of epidural analgesia.
This prospective study shows that an epidural catheter inserted through a needle oriented in the cephalad direction increases the success of labor analgesia in the parturient. Carefully rotating the needle cephalad does not increase the risk of dural puncture, intravascular catheters, or failed blocks.
不对称感觉阻滞和硬膜穿刺都是硬膜外镇痛的不良后果。将穿刺针斜面与患者背部纵轴平行来确定硬膜外间隙，可降低硬膜穿刺时发生头痛的风险。然而，将斜面旋转以使导管头端朝上可能会有硬膜穿刺的风险。我们前瞻性地研究了穿刺针旋转对分娩硬膜外镇痛成功率和硬膜穿刺发生率的影响。160例美国麻醉医师协会（ASA）身体状况为I或II级的分娩产妇被随机分为四组。用18号Hustead穿刺针斜面指向患者左侧来确定硬膜外间隙。然后按如下方式旋转：0组 = 不旋转，最终斜面方向朝左（n = 39）；90组 = 顺时针旋转90度，斜面朝上（n = 43）；180组 = 顺时针旋转180度，斜面朝右（n = 36）；270组 = 顺时针旋转270度，斜面朝下（n = 42）。插入单孔导管3厘米，并以标准化方式诱导镇痛。硬膜穿刺在各组中分布均匀（4.4%）。当穿刺针斜面朝上时，在30分钟时阻滞的皮节更多，单侧阻滞更少，更多患者感觉舒适。使用通过朝头端方向的穿刺针插入的导管可提高硬膜外镇痛的成功率。
这项前瞻性研究表明，通过朝头端方向的穿刺针插入硬膜外导管可提高产妇分娩镇痛的成功率。小心地将穿刺针朝头端旋转不会增加硬膜穿刺、血管内导管置入或阻滞失败的风险。
