侧隐窝入路低位硬膜外麻醉用于老年单侧下肢手术的临床观察

Low epidural anesthesia through lateral crypt access on half lower extremity surgery for elderly patients

目的观察L5～S1侧隐窝入路硬膜外置管麻醉用于老年患者单侧下肢手术的可行性及安全性。方法22例常规入路硬膜外穿刺失败的老年患者,采取L5～S1小关节内缘入路进行硬膜外侧隐窝穿刺置管,成功后进行硬膜外麻醉。记录硬膜外给药前后及术毕患者的血压、脉搏、双侧麻醉平面麻醉效果及辅助药物的用量。结果1例穿刺不成功,1例效果欠佳,改全身麻醉,余20例麻醉成功,硬膜外给药后15min18例患者出现双侧平面差异,术后8例仍有平面差异。硬膜外给药给药后15、30min的收缩压、舒张压、心率与术前比较下降,差异有统计学意义,P<0.05;给药后5min、手术开始5min,收缩压、舒张压、心率与术前比较略下降,但差异无统计学意义,P>0.05。结论侧隐窝入路低位硬膜外麻醉用于老年下肢手术有效、安全,可作为常规入路椎管内麻醉的备选方法。

Objective To determine the feasibility and safeness of epidural anesthesia on half lower extremity surgery for elderly patients using epidural catheter placement on lateral crypt of L5 - S1. Methods 22 cases of elderly patients who had received an unsuccessful epidural puncture with conventional approach were given a puncture tube placement through the inner edge of the small joints of L5 -S1. After the procedure had completed successfully, epidural eatherterization was given to each patient. Then we take a record of the patients＇blood pressure, pulses, the anesthetic effect of the bilateral anesthetic planes and the use of adjunctive drugs. Results Despite of a failure in puncture of one case and the poor effect in another case which had to turn to general anesthesia, 20 cases turned out to be a success. Differences between the two sides of anesthetic planes were found in 18 cases after 15 min of epidural anesthesia. The anesthetic plane in the puncture side was up to T6, with the contralateral one to Ts. There were still anesthetic plane differences after surgery found in 8 cases. The systolic blood pressure, diastolic blood pressure and heart rate decreased slightly 15 rain and 30 rain after epidural administration,P 〈 0. 05 ; The systolic blood pressure, diastolic blood pressure and heart rate decreased slightly 5 rain after epidural anesthesia and 5 rain after the surgery began, but the difference was not statistically significant, P 〉 0.05. Conclusion It is safe and effective to apply the low epidural anesthesia with lateral crypt access for the low-extremity surgery with elderly patients, which can be a second resort of spinal anesthesia if the conventional approach fails.