Richardson M G, Wissler R N
Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Strong Memorial Hospital, New York 14642, USA.
Anesth Analg. 1999 Feb;88(2):352-6. doi: 10.1097/00000539-199902000-00024.
Lateral needle bevel orientation during identification of the epidural space has been recommended to reduce the risk of postdural puncture headache (PDPH). Rotation to cephalad or caudad orientation before catheter insertion is assumed necessary for analgesic success. We prospectively compared the effects of catheter insertion through lateral- and cephalad-oriented Tuohy needle bevels in laboring parturients. Anesthesiology residents were randomized to identify the epidural space with bevels oriented cephalad or lateral. Catheters were inserted without needle rotation. Outcomes compared included ease of insertion, analgesic effectiveness, and complications. We evaluated 534 catheter insertions in 500 parturients. Initial catheter insertion produced satisfactory analgesia in 80.2% of the lateral group versus 91.1% of the cephalad group (P < 0.001). Resistance preventing catheter insertion accounted for the difference. There were no differences in i.v. cannulation (5.8% vs 5.1%), dural puncture (3.8% vs 2.0%), PDPH (0.4% vs 0.7%), or asymmetric block (31% vs 27%). There was a slightly higher rate of paresthesias in the lateral group (31% vs 23%; P = 0.048). In 78% of parturients experiencing both paresthesias and asymmetric block, the side of the paresthesia and greater extent of block were the same. Analgesic effectiveness, as measured by using a visual analog scale, was not different between the groups.
Two methods of epidural catheter insertion were compared in laboring parturients. Catheter insertion with the needle orifice oriented cephalad was associated with the greatest initial success and the fewest complications.
在确定硬膜外间隙时采用侧入法针斜面方向，已被推荐用于降低硬膜穿破后头痛（PDPH）的风险。在置管前将针斜面旋转至头端或尾端方向被认为是镇痛成功的必要条件。我们前瞻性地比较了在分娩产妇中通过头端方向和侧入法的Tuohy针斜面置管的效果。麻醉住院医师被随机分为用头端方向或侧入法的斜面来确定硬膜外间隙。置管时不旋转针。比较的结果包括置管的难易程度、镇痛效果和并发症。我们评估了500例产妇的534次置管。初次置管时，侧入法组80.2%的产妇获得了满意的镇痛效果，而头端方向组为91.1%（P<0.001）。阻止置管的阻力导致了这种差异。静脉穿刺（5.8%对5.1%）、硬膜穿刺（3.8%对2.0%）、PDPH（0.4%对0.7%）或不对称阻滞（31%对27%）方面无差异。侧入法组感觉异常的发生率略高（31%对23%；P=0.048）。在同时出现感觉异常和不对称阻滞的产妇中，78%感觉异常的一侧与阻滞范围较大的一侧相同。两组间采用视觉模拟评分法测量的镇痛效果无差异。
在分娩产妇中比较了两种硬膜外置管方法。针孔朝头端方向置管初始成功率最高且并发症最少。
