The coiling length of thoracic epidural catheters: the influence of epidural approach angle
The coiling length of thoracic epidural catheters: the influence of epidural approach angle
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DOI：
10.1093/bja/ael361
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发表时间：
2007-03-01
影响因子：
9.8
通讯作者：
Lim, Y. -J.
中科院分区：
文献类型：
--
作者：
Ryu, H. -G.;Bahk, J. -H.;Lim, Y. -J.
背景胸硬膜外导管用于麻醉和术后镇痛。通常情况下，硬膜外导管放置没有确认其位置，尽管经常报告的并发症，由于错位。在这项研究中，我们评估了无弹簧圈的胸椎硬膜外导管的螺纹长度，并评估了两种不同的硬膜外入路角度对无弹簧圈的螺纹长度的影响。入组83例拟行开胸手术的患者，随机分为锐角组和钝角组。在两组中，在T8-9椎间节段进行皮肤插入。在X线透视下使用旁正中入路在锐角组的T7-8节段和钝角组的T6-7节段进行硬膜外入路，并插入端孔19号硬膜外导管。测量两组患者的盘绕长度，即导管的任何部分刚开始向尾侧头时导管在硬膜外腔内的长度。钝角组弹簧圈长度为7.4（4.4）cm（95%CI 6.0-8.7 cm），锐角组为4.9（3.3）cm（95%CI 3.8-6.0 cm）（P = 0.005）。以钝角入路进入胸段硬膜外腔可提供更长的弹簧圈长度。我们建议使用钝角入路，以最大限度地增加导管到达预期水平的机会，同时最大限度地降低弹簧圈栓塞的风险。
Background. Thoracic epidural catheters are used for anaesthesia and postoperative analgesia. Usually, epidural catheters are placed without confirmation of their position despite frequent reports of complications as a result of malposition. In this study, we evaluated the threading length of thoracic epidural catheters without coiling and assessed the influence of two different epidural approach angles on the threading length without coiling.Methods. Eighty-three patients scheduled for thoracotomy were enrolled and randomly allocated into the acute angle group and the obtuse angle group. In both groups, skin insertion was performed at the T8-9 intervertebra level. Epidural access was performed under fluoroscopy using a paramedian approach at the T7-8 level in the acute angle group and at the T6-7 level in the obtuse angle group, and an end-hole 19-gauge epidural catheter was inserted. Coiling length, defined as the length of the catheter within the epidural space when any part of the catheter just begins to head caudally, was measured in both groups.Results. The coiling length was 7.4(4.4) cm (95% CI 6.0-8.7 cm) in the obtuse angle group compared with 4.9(3.3) cm (95% CI 3.8-6.0 cm) in the acute angle group (P = 0.005).Conclusions. Approaching the thoracic epidural space with an obtuse approach angle provides longer coiling length. We recommend that an obtuse approach angle should be used to maximize the chance of the catheter reaching the intended level with minimum risk of coiling.