Spinal anestezide yeni bir yöntem: Dental iğne ve aspirasyon

Bu prospektif çalışmada, dental iğne ve aspirasyon yöntemi ile spinal anestezi (SA) 'nin uygulama detayları ve etkinliği araştırıldı. ASA I-II grubu 205 olgu iv serum fizyolojik infüzyonuna başlandıktan sonra monitörize edildi. SA uygulamasında 2 adet steril, tek kullanımlık enjektör kullanıldı. Bunlardan birincisi 2 mL'lik dental (0.40 x 50 mm) uçlu, ikincisi 5 mL'lik normal uçlu idi. 5 mL'lik enjektöre normal uç ile 80 mg lidokain ve 0.025 mg epinefrin çekildi. Ucu dental iğne ile değiştirilen bu enjektör, oturur ve sağ yan yatan pozisyondaki olgulara, enjeksiyonun yapılacağı noktaya 0.5 mL lokal anestezi (LA) yapılarak yavaş ve dikkatlice ilerletildi. En küçük bir direnç, kemiğe temas kabul edildi. Bu durumda, iğne cilt altına çekildi, tekrar yönlendirildi ve ilerletildi. İğnenin tamamının sorunsuz olarak intratekal aralığa girdiği düşünülen olgularda, iğnenin uzun ekseni çevresinde 90 derece döndürülüp enjektör çizgilerine bakılarak pistona negatif basınç uygulandı. Sıvının 0.5 - l mL anması BOS aspirasyonu kabul edildi ve enjektördeki LA ve BOS karışımı (70 mg lidokain) intratekal aralığa verilmeye başlandı. Olguya duyu değişiklikleri sorularak işlemin olumluluğu doğrulandı. SA uygulanan 205 olgudan 4'ünde (% 2) spinal aralığa ulaşılamadı ve standart SA uygulandı. 25 olguda (% 12.5) iğnenin tamamı 0.5 cm daha fazla ilerletildikten sonra spinal aralığa ulaşılıp LA verilebildi. Çoğunluğu bu olgularda (14) olmak üzere 17 (% 8.3) olguda operasyon sırasında anestezi yetersizliği gelişti, bu olgularda intravenöz anestezi uygulamasına geçildi. Başarısızlık oranı % 10.3 oldu. 201 olguda 239 dental iğne kullanıldı. 178 olguda (% 89) birinci, 20 olguda (% 10) ikinci, 3 olguda ( % 1.5) ise üçüncü iğnede başarıya ulaşılabildi. Dental iğne ile SA uygulanan 201 olgudan l'inde (% 0.5) postural, diğer l 'inde (% 0.5) ise non-postural baş ağrısı gelişti. Sonuç olarak, enjektörlü dental iğne ve aspirasyon yöntemi ile yapılan SA uygulamasının; olguların yaklaşık % 90' ında manüplasyonun kolay olduğu, yan etkisinin çok az, pratik, güvenli ve ekonomik yöntem olabileceği kanısına varıldı.

Anahtar Kelimeler:

İleriye dönük çalışma, Beyin omurilik sıvısı, Anestezi, spinal, Baş ağrısı, İğneler

New technique in spinal anesthesia: Dental needle and aspiration

In this prospective study, we defined a new spinal anesthetic (SA) technique with a 27 G dental needle and confirmation method of aspiration of the cerebrospinal fluid (CSF) through this needle. We explained the details of this procedure, and investigated the feasibility of it. Two hundred five patients from ASA I-II were monitored after the beginning of iv 0.9 % NaCl in-fusion. Only two syringes were used during this SA procedure; one of them is 2 mL syringe with 27 G dental (0.40 x 50 mm) needle, and another is 5 mL with normal (22 G) needle. Big syringe was filled with 4 mL 2 % lidocaine mixed with 0.025 mg epinephrine with normal needle. Then, dental needle was fitted to this syringe. This prefilled syringe and dental needle set was inserted into the cases sitting or right side position by midline approach as bevel paralel to dural fibers. During insertion, we injected 0.5 mL local anesthetic into the skin and subcutaneous tissue. During this procedure, in case of determining resistan-ce, we pulled back the needle to skin and reinserted it in an another direction. Upon the third bone contact time, a new needle was selected. Successful dural puncture was confirmed with either aspiration of CSF through the dental needle or patient responces to neutral stimuli. We couldn't reach to the spinal space (SS) in the 4 (2 %) cases, because of shortness of dental needles (50 mm). We reached the SS hardly in 25 cases (12 %). Spinal analgesia was failed in 17 cases (8.3 %) and iv anesthesia was applied to these cases. Our total failure rate was 10.3 %. We used 239 dental needles in 201 cases. The rate of a successful dural puncture by the first needle, the second needle, and the third needle were 89 % (178), 10 % (20), and 1.5 % (3), respectively. We found two postspinal puncture headache in 201 cases, one of them (0.5 %) was postural and the another (0.5 %) was non-postural type. Success rate of dural puncture was high (85 %) by aspiration of CSF through dental needle. In conclusion, this new SA technique with the use of prefilled syringe dental needle set and confirmation method of the cerebrospinal fluid through dental needle is easy, practical, safe, cheaper to perform to approximately in 90 % of the cases.

Keywords:

Prospective Studies, Cerebrospinal Fluid, Anesthesia, Spinal, Headache, Needles,

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