IS IT NECESSARY TO ROTATE THE EPIDURAL NEEDLE TO OBTAIN SUCCESSFUL SACRAL SEGMENT BLOCK?

應否轉動Tuohy Needle以達成薦部神經阻斷

林昭傑(Chao-Chieh Lin)；范守仁(Shou-Zen Fan)；黃芳彥(Fan-Yen Huang)；林仙養(Shian-Yeang Lin)

Epidural block ； Dural puncture.

Acta Anaesthesiologica Sinica

28卷3期（1990 / 09 / 01）

317 - 321

英文

The effect of rotating the lerel of touhy needle to obtain successful sacral blockade was controversial. During the rotation, dural puncture was reported by some studies. In our study, we divided forty patients into two groups randomly. They all belonged to ASA I-II, receiving epidural needle insertion at L 2-3 epidural space, before epidural catheter was inserted. Total of 10 mL of 2% xylocaine was injected into the epidural space. In group A, the bevel of Tuohy needle was pointed upward, that is, parallel to the ligament flavum. In group B, the bevel was pointed caudally. We determined the cutaneous extension of loss of cold sensation by using a swab of cotton wool soaked with alcohol 15 min and 25 min after the test injection. Our result showed no different in loss of cold sensation in sacral area between these these two groups. So we concluded that there is no need to rotate the epidural needle for sacral blockade.

在硬脊膜外麻醉時，轉動Tuohy needle對局部麻醉劑散佈的影嚮，一直為大家所感興趣的。有些報告認為把Tuohy needle朝向尾端而注入局部麻醉劑可獲得成功的薦部神經阻斷，但也有報告指出在轉動Tuohy needle時常會把硬脊膜穿破，因此不建議轉動Tuohy needle。本實驗把四十位病人分為兩組，每組二十位，每位病人接受在L2-3插入Tuohy needle至硬脊膜外腔。第一組病人是當Tuohyneedle缺口朝上時，先注入3mL 2% Xylocaine作為測試劑，然後在5秒內注入7 mL的2% Xylocaine。第二組的病人先經過3 mL的2% Xylocaine測試後，把Tuohy needle缺口朝向尾端，以同樣速度注入7 mL的2% Xylocaine。在注射後的15分鐘和25分鐘，分別測定病人神組阻斷的範圍，測定的方法是利用病人當神經被阻斷時對冷覺的反應。本實驗的結果是這兩組病人在薦部神經阻斷上沒有臨床上的差異。所以不需為要達成薦部神經阻斷而轉動Tuohy needle，而增加穿破硬脊膜的機會。