Cold Sensitivity Test Cannot Eliminate Epidural Catheter Misplacement-Minimal Perception Current Measurement as a Novel Technology to Quantitatively Evaluate an Epidural Blockade

導管錯置到助膜腔中為置放硬脊膜外導管的少見併發症。這個病歷報告呈現的是一位因頭頸部腫瘤經手術、放射治療後的患者，在進行胸腔腫瘤切除術前，接受硬脊膜外導管置放，以作為術後使用自控式止痛之用。然而雖然這個病例導管置放是在非麻醉狀態下進行，且使用了阻力消失、負壓回抽、與低溫感覺測試等方法來確認導管的位置，卻仍然無法避免將硬脊膜外導管錯置到肋膜腔中。文中探討錯置的導管沒有被及早發現的原因，並提出定量評估硬脊膜外阻斷程度的新技術，希望藉以及早診斷硬脊膜外導管錯置的狀況。在美國麻醉醫學會2007年的年會中，Yamakage等學者發表一研究報告，透過測量最小感知電流藉以評估皮膚敏感度與老化的關係。查閱文獻發現，最小感知電流未曾被應用於硬脊膜外阻斷的定量評估。考量到一般使用低溫感覺測試來評估硬脊膜外阻斷的效果，只能比較不同皮節的感覺差異。然而，如報告中的病例，不同皮節的感覺差異是很有可能原本就存在的。因此當某部位低溫感覺較低，可能是阻斷成功，或者是該部位原有的感覺差異所造成。我們主張透過測量同一部位在進行硬脊膜外阻斷前與阻斷後的最小感知電流，來定量地評估阻斷的效果，進而可以及早發現導管錯置的狀況，減少低溫感覺測試的誤差。未來更可望將最小感知電流測量之技術應用於其他神經阻斷與疼痛治療之範疇。

關鍵字

最小感知電流；神經阻斷； Painvision®

並列摘要

Interpleural misplacement is a rare complication of epidural catheter insertion. We report a case in which the combination of catheter placement in an awake patient, loss of resistance technique, negative aspiration as well as cold sensitivity test failed to identify epidural catheter misplacement. The possible reasons for the failure to diagnose the misplacement of the epidural catheter are discussed. A novel technique to quantitatively evaluate an epidural blockade which may aid in early diagnosis of epidural catheter misplacement was introduced. While evaluating an epidural blockade by cold sensitivity test, the decrease in cold sensitivity may reflect the effect of blockade or preexisting sensitivity variation, as in the case. A more reliable method was mandatory to evaluate epidural blockade and may aid in confirmation of epidural catheter placement. At the 2007 annual meeting of the American Society of Anesthesiologists, Yamakage et al presented their study on skin sensitivity and aging by measuring minimal perception current (MPC) with Painvision . While there was no studies regarding the application of MPC to quantitatively evaluate epidural neural blockade been published, we suggest that by comparing the MPC measured by Painvision before and after epidural blockade, the intensiveness and the coverageof se ns or y blockade could be quantitatively measured. Unexplained weak or ineffective block which may resulted from a misplaced epidural catheter could be identified before a failed block does happen.

並列關鍵字

Minimal perception current ； Nerve blockade ； Painvision®

國際替代計量

Cold Sensitivity Test Cannot Eliminate Epidural Catheter Misplacement-Minimal Perception Current Measurement as a Novel Technology to Quantitatively Evaluate an Epidural Blockade

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