Ultrasound-guided thoracic paravertebral puncture and placement of catheters in human cadavers: where do catheters go?
Ultrasound-guided thoracic paravertebral puncture and placement of catheters in human cadavers: where do catheters go?
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DOI：
10.1093/bja/aeq309
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发表时间：
2011-02-01
影响因子：
9.8
通讯作者：
Eichenberger, U.
中科院分区：
文献类型：
--
作者：
Luyet, C.;Herrmann, G.;Eichenberger, U.
背景椎旁区域麻醉用于治疗几种外科手术后的疼痛。本研究旨在改进我们首次发表的超声引导下椎旁间隙（PVS）入路，并调查针、导管和造影剂位置之间可能存在的差异。在10具尸体中，我们进行了26次超声引导椎旁入路结合阻力损失（LOR），并在中期分析后进行了36次新的纯超声引导（PUSG）椎旁入路。通过首次计算机断层扫描（CT）控制针尖位置。放置导管后，通过第二次CT评估头端，并通过进一步CT扫描评估注射造影剂的扩散。以椎间隙附近的PVS为主要靶点。评估62个针尖的首次CT扫描显示：13个（50%）LOR和34个（94%）PUSG入路位于靶点; 2个（8%）LOR和无PUSG入路位于PVS外。通过第二次CT扫描，分析了60个导管头端位置：3个（12%）LOR和5个（14%）PUSG入路位于靶点，3个（12%）LOR和2个（6%）PUSG入路位于PVS外。硬膜外腔中未检测到导管。在2例病例中，无法插入导管。在硬膜外造影的病例中，最宽的造影剂扩散范围为7.7（3.5）[平均值（SD）]个椎体节段。我们新的PUSG技术在椎旁穿刺针放置方面具有很高的成功率。虽然针被正确定位，但导管通常被发现远离针尖位置。
Background. Paravertebral regional anaesthesia is used to treat pain after several surgical procedures. This study aimed to improve on our first published ultrasound-guided approach to the paravertebral space (PVS) and to investigate a possible discrepancy between the needle, catheter, and contrast dye position.Methods. In 10 cadavers, we conducted 26 ultrasound-guided paravertebral approaches combined with loss of resistance (LOR) and after an interim analysis performed 36 novel, pure ultrasound-guided (PUSG) paravertebral approaches. Needle-tip position was controlled by a first computed tomography (CT) scan. After placement of the catheters, the tips were assessed by a second CT and the spread of injected contrast dye was assessed by further CT scans. The part of the PVS near the intervertebral foramen was defined as the primary target to reach.Results. The first CT scans assessing 62 needle tips revealed that: 13 (50%) of LOR and 34 (94%) of PUSG approaches were at the target; and two (8%) LOR and no PUSG approaches were outside the PVS. With the second CT scans 60 catheter-tip positions were analysed: three (12%) of LOR and five (14%) of PUSG approaches were at the target, three (12%) of LOR and two (6%) of PUSG approaches were outside the PVS. No catheters were detected in the epidural space. In two cases, insertion of the catheter was not possible. In cases with major epidural contrast, the widest contrast dye spread was 7.7 (3.5) [mean (SD)] vertebral segments.Conclusions. Our new PUSG technique has a high success rate for paravertebral needle placement. Although needles were correctly positioned, catheters were usually found distant from the needle-tip position.