An Alternative Continuous Caudal Block with Caudad Catheterization via Lower Lumbar Interspace in Adult Patients

背景：往尾端置入導管的持續性尾椎阻斷術的研究尚未在文獻中出現。我們設計一初步研究探討其技術上的可能性，顯影劑的分佈，與臨床的效果。方法：十名接受肛門或陰道手術的病人隨機分成兩組，由中線或側中途逕經腰椎第四和第五節之間施行硬脊膜外導管置放，硬脊膜外導管穿過Touhy針管並向尾端放入十公分長。置放導管期間，感覺異常之有無與置放導管之難易均說細記載。然後，有X光透視下，從硬脊膜外導管注射顯影劑iohexol(omnipaque 300mg/ml)研究導管在硬脊膜外腔的走向與顯影劑的分佈情形。做完X光檢查，病人被送到開刀房。經由硬脊膜外導管注射第一劑量2% lidocaine的十五分鍾後，檢查病人的感覺麻醉範圍與動動阻斷程度。麻醉期間，任何不良事件均需給予評估和處理。結果：在九名病人身上，硬脊膜外導管置放被視爲容易，而且沒有感覺異常發生。在一名病人身上，雖然硬脊膜外導管置放遇到中度的阻力，導管依然成功地置入預定的長度。籍由顯影劑輔助的X光檢查，硬脊膜外導管的走向並非每次都可以看到，顯影劑的擴散則都可以清晰易辨。八名病人是硬脊膜外腔分佈，一名病人是左脊椎側腔分佈，和一名病人是右直腸後腔分佈。在臨床評估方面，八名病人只需要局部麻醉藥即可獲致足夠的感覺神經阻斷，並且下肢保有良好動運功能；一名病人在導管拉回五公分後仍然能獲得足夠的尾椎阻斷；一名病人則由於尾椎阻斷失敗而接受脊椎麻醉。結論：經下位腰椎間隙往尾端置入導管的另一種持續性尾椎阻斷術，在技術層面和臨床效果兩方面，均可能獲致完全的阻斷效果（本研究的十名病人中有八名）。導管除了會偏走入脊椎側腔外，即使在導管置放非常置放非常順利的情形下，它也可能偏走入直腸後腔。兩者均可能造成這種持續性尾椎阻斷術的失敗。

關鍵字

硬脊膜外麻醉；腰椎；尾椎神經阻斷術

並列摘要

Background: Continuous caudal block with caudad catheterization has not yet been mentioned in literatures. We designed a preliminary study to investigate the feasibleness of this technique, spread of contrast medium under fluoroscopy, and its clinical effectiveness. Methods: Ten patients were subjected to epidural block (caudal) for elective anal or vaginal procedures. The entry of the epidural needle was made at the L(subscript 4-5) interspace either with midline or paramedian approach. Through an 18 G Touhy needle with its bevel facing caudally an epidural catheter was threaded until a length of 10cm was beyond the point of entry. The presence or absence of paresthesia during the passage of catheter and the ease with which the catheter was inserted were recorded. After the procedure, the course on which the catheter traversed and the spread of the medicinal substance in the epidural space were visualized and studied fluoroscopically using 1 and 3 ml iohexol (omnipaque 300 mg/ml)as contrast medium respectively. Then the patients were brought to operating rooms for anesthesia and surgery. Sensory anesthetic level and motor blockade were evaluated fifteen mm after 11-15ml of 2% lidocaine had been injected through the epidural catheter. During anesthesia vital signs were closely monitored, and adverse reaction if any was evaluated and managed. Results: The insertion of the epidural catheter was considered easy and caused no paresthesia in nine patients. Catheter insertion encountered moderate resistance and induced paresthesia in one patient. Yet, the catheter was advanced successfully to the expected length. In radiological study with contrast medium, the course of the epidural catheter was not always traceable, while the spread of the contrast medium was clearly identified. Epidural spread occurred in eight patients, left paravertebral spread in one patient, and right retrorectal spread in another one patient. As to clinical assessment, adequate sensory blockade with local anesthetic was gained in 8 patients with well-preserved motor function of the lower limbs. In one patient the caudal block worked well after the with-drawl of the catheters cm in length. Spinal anesthesia was supplemented in one patient due to failure of the caudal block Conclusions: Continuous caudal block with caudawise catheterization via lower lumbar interspaces is feasible (eight of 10 patients in this study) with respect to technique and clinical effect. Paravertebral and retrorectal migrations of the catheter may occur in spite of smooth catheterization. Either migration might lead to a failure of caudal block.

並列關鍵字

Anesthesia, epidural ； Lumbar vertebrae ； Nerve block, caudal

國際替代計量

An Alternative Continuous Caudal Block with Caudad Catheterization via Lower Lumbar Interspace in Adult Patients

全文下載

主題瀏覽