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Full-Endoscopic Removal of Sheared Lumbar Epidural Catheter Fragment.

全内镜下切除剪切的腰椎硬膜外导管碎片。

  • 影响因子:1.52
  • DOI:10.1016/j.wneu.2020.02.111
  • 作者列表:"Siddappa ND","Kim JS","Khandge AV
  • 发表时间:2020-05-01
Abstract

BACKGROUND:An epidural nerve block injection is the most common modality of treatment for control of low backache associated with radiating pain. Epidural catheter injections are also widely used by pain physicians to control cancer pain. Epidural catheters could be associated with procedure-related complications, such as epidural hematoma, epidural abscess, and post-dural puncture headache, and rare complications, such as shearing or breakage of the catheter tip. In this report, we describe the full-endoscopic removal of a sheared epidural catheter fragment. CASE DESCRIPTION:A man aged 24 years presented with low backache radiating to his left leg with numbness and weakness. Left-sided L4-L5 disc herniation was diagnosed on magnetic resonance imaging, and the patient was posted for an epidural nerve block. The epidural catheter broke during removal, and a 4-cm fragment was retained in the epidural space. We performed an interlaminar full-endoscopic removal of the sheared epidural catheter. Postoperatively, the patient reported excellent clinical outcome. CONCLUSIONS:Interlaminar full-endoscopic procedure could be used for the removal of the retained epidural catheter as a practical option.

摘要

背景: 硬膜外神经阻滞注射是控制与放射性疼痛相关的腰痛的最常见治疗方式。硬膜外导管注射也被疼痛医师广泛用于控制癌症疼痛。硬膜外导管可能与手术相关的并发症有关,如硬膜外血肿、硬膜外脓肿和硬脑膜穿刺后头痛,以及罕见的并发症,如导管尖端的剪切或断裂。在本报告中,我们描述了全内窥镜切除剪切的硬膜外导管碎片。 病例描述: 一名24岁男子,出现左腿放射的腰痛,伴有麻木和无力。在磁共振成像上诊断左侧L4-L5椎间盘突出,并且患者被张贴为硬膜外神经阻滞。硬膜外导管在取出过程中断裂,在硬膜外腔中保留了一个4厘米的碎片。我们实施了经剪切的硬膜外导管的层间全内窥镜移除。术后,患者报告良好的临床结果。 结论: 椎板间全内镜手术可作为保留硬膜外导管的一种实用选择。

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影响因子:2.27
发表时间:2020-01-01
DOI:10.1213/ANE.0000000000003975
作者列表:["Uppal V","Retter S","Casey M","Sancheti S","Matheson K","McKeen DM"]

METHODS:BACKGROUND:Fentanyl and morphine are the 2 most commonly added opioids to bupivacaine for spinal anesthesia during cesarean delivery. Numerous clinical trials have assessed efficacy and safety of different doses of fentanyl added to intrathecal bupivacaine for spinal anesthesia, yet its benefit, harm, and optimal dose remain unclear. This study aimed to systematically review the evidence of the efficacy of fentanyl when added to intrathecal bupivacaine alone and when added to bupivacaine with morphine for spinal anesthesia during cesarean delivery. METHODS:Key electronic databases (PubMed, Embase, and Cochrane Library) were searched for randomized controlled trials in the cesarean delivery population. The primary outcome was the failure rate of spinal anesthesia, as assessed by the need for either conversion to general anesthesia or intraoperative analgesic supplementation. Two reviewers independently extracted the data using a standardized electronic form. Results are expressed as relative risks or mean differences with 95% CIs. RESULTS:Seventeen randomized controlled clinical trials (most judged as low or unclear risk of bias) with 1064 participants provided data for the meta-analysis. Fentanyl added to intrathecal bupivacaine alone reduced the need for intraoperative supplemental analgesia (relative risk, 0.18; 95% CI, 0.11-0.27; number needed to treat, 4) and the incidence of nausea/vomiting (relative risk, 0.41; 95% CI, 0.24-0.70; number needed to treat, 6.5), with longer time to first postoperative analgesia request (mean difference, 91 minutes; 95% CI, 69-113). No difference was observed regarding the need for conversion to general anesthesia (relative risk, 0.67; 95% CI, 0.12-3.57), the incidence of hypotension, the onset of sensory block, or the duration of motor block. However, the addition of intrathecal fentanyl was associated with higher incidence of intraoperative pruritus (relative risk, 5.89; 95% CI, 2.07-16.79; number needed to harm, 13.5). The inclusion of fentanyl to intrathecal bupivacaine-morphine compared to intrathecal bupivacaine-morphine alone conferred a similar benefit, with a significantly reduced need for intraoperative supplemental analgesia (relative risk, 0.16; 95% CI, 0.03-0.95; number needed to treat, 9). Analysis using a funnel plot indicated a possibility of publication bias in included studies. CONCLUSIONS:Current evidence suggests a benefit of using fentanyl as both an additive to intrathecal bupivacaine alone and to intrathecal bupivacaine combined with morphine for cesarean delivery under spinal anesthesia. The possibility of publication bias, small sample size, and high risk of bias in some of the included studies warrant treating the results with caution.

关键词: 暂无
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影响因子:2.27
发表时间:2020-05-01
DOI:10.1213/ANE.0000000000004012
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