PDF(Pubmed)
Abstract：
BACKGROUND: Pre-procedural ultrasound can be used to identify the subarachnoid space in difficult spinal procedures. However, multiple punctures can result in numerous complications, including post-dural puncture headache, neural trauma, and spinal and epidural haematoma. Thus, the following hypothesis was proposed: in contrast to the conventional blind paramedian dural puncture, pre-procedural ultrasound results in a successful dural puncture on the first attempt.
METHODS: In this prospective, randomised controlled study, 150 consenting patients were randomly assigned to one of the two groups: ultrasound-guided paramedian (UG) and conventional blind paramedian (PG). In the UG paramedian group, pre-procedural ultrasound was performed to mark the insertion site, whereas, in the PG group, the landmark technique was used. A total of 22 different anaesthesiology residents performed all subarachnoid blocks.
RESULTS: The time taken to perform spinal anaesthesia in the UG group was 38-49.5 s, which is shorter than the time taken in the PG group, which was 38-55 s, with a p-value < 0.046, which is statistically significant. The primary outcome of a successful dural puncture on the first attempt was not significantly higher in the UG group (49.33%) than in the PG group (34.67%), with a p-value < 0.068. The number of attempts taken for a successful spinal tap in the UG group was a median of 2.0 (1 to 2), and the PG group had a median of 2 (1 to 2.5), with a p-value < 0.096, which is statistically non-significant.
CONCLUSIONS: Ultrasound guidance showed improvement in the success rate of paramedian anaesthesia. In addition, it improves the success rate of dural puncture and the rate of puncture on the first attempt. It also shortens the time required for a dural puncture. In the general population, the pre-procedural UG paramedian group did not outperform the PG paramedian group.
METHODS: In this prospective, randomised controlled study, 150 consenting patients were randomly assigned to one of the two groups: ultrasound-guided paramedian (UG) and conventional blind paramedian (PG). In the UG paramedian group, pre-procedural ultrasound was performed to mark the insertion site, whereas, in the PG group, the landmark technique was used. A total of 22 different anaesthesiology residents performed all subarachnoid blocks.
RESULTS: The time taken to perform spinal anaesthesia in the UG group was 38-49.5 s, which is shorter than the time taken in the PG group, which was 38-55 s, with a p-value < 0.046, which is statistically significant. The primary outcome of a successful dural puncture on the first attempt was not significantly higher in the UG group (49.33%) than in the PG group (34.67%), with a p-value < 0.068. The number of attempts taken for a successful spinal tap in the UG group was a median of 2.0 (1 to 2), and the PG group had a median of 2 (1 to 2.5), with a p-value < 0.096, which is statistically non-significant.
CONCLUSIONS: Ultrasound guidance showed improvement in the success rate of paramedian anaesthesia. In addition, it improves the success rate of dural puncture and the rate of puncture on the first attempt. It also shortens the time required for a dural puncture. In the general population, the pre-procedural UG paramedian group did not outperform the PG paramedian group.
摘要：
背景：术前超声可用于在困难的脊柱手术中识别蛛网膜下腔。然而,多次穿刺可导致多种并发症，包括硬脑膜穿刺后头痛,神经创伤,脊髓和硬膜外血肿.因此，提出了以下假设：与传统的盲旁硬脑膜穿刺相反，术前超声在第一次尝试中成功穿刺硬脑膜.
方法：在此前瞻性中，随机对照研究，150名同意的患者被随机分配到两组中的一组：超声引导下的旁观（UG）和常规盲旁观（PG）。在UG参数组中，术前超声标记插入部位,然而,在PG组，使用了具有里程碑意义的技术。共有22名不同的麻醉科居民进行了所有蛛网膜下腔阻滞。
结果：UG组进行脊髓麻醉的时间为38-49.5s，比PG组的时间短，这是38-55年代，p值<0.046，具有统计学意义。首次尝试成功硬脑膜穿刺的主要结果UG组（49.33％）未明显高于PG组（34.67％），p值<0.068。在UG组中，成功进行脊柱穿刺的尝试次数中位数为2.0（1至2），PG组的中位数为2（1至2.5），p值<0.096，这在统计学上是不显著的。
结论：超声引导显示，辅助麻醉的成功率提高。此外,提高了硬脑膜穿刺成功率和首次穿刺率。它还缩短了硬脑膜穿刺所需的时间。在一般人群中,术前UG参数组没有超过PG参数组.
方法：在此前瞻性中，随机对照研究，150名同意的患者被随机分配到两组中的一组：超声引导下的旁观（UG）和常规盲旁观（PG）。在UG参数组中，术前超声标记插入部位,然而,在PG组，使用了具有里程碑意义的技术。共有22名不同的麻醉科居民进行了所有蛛网膜下腔阻滞。
结果：UG组进行脊髓麻醉的时间为38-49.5s，比PG组的时间短，这是38-55年代，p值<0.046，具有统计学意义。首次尝试成功硬脑膜穿刺的主要结果UG组（49.33％）未明显高于PG组（34.67％），p值<0.068。在UG组中，成功进行脊柱穿刺的尝试次数中位数为2.0（1至2），PG组的中位数为2（1至2.5），p值<0.096，这在统计学上是不显著的。
结论：超声引导显示，辅助麻醉的成功率提高。此外,提高了硬脑膜穿刺成功率和首次穿刺率。它还缩短了硬脑膜穿刺所需的时间。在一般人群中,术前UG参数组没有超过PG参数组.
