关键词: 脊椎麻醉, 改良针内针穿刺技术, 超声检查, 关节置换术, 全髋关节

Abstract:

Objective：To discuss the application of the modified needle-through-needle puncture technique in unilateral total hip arthroplasty in the elderly patients，and to clarify its anesthetic effect and feasibility in the single isospecific gravity spinal anesthesia guided by ultrasound. Methods Sixty elderly patients underwent elective unilateral hip arthroplasty with single isobaric gravity spinal anesthesia were selected. The puncture was performed in the patients with the affected side upper in the lateral position. Sixty patients were divided into tradition group and modification group， and there were 30 patients in each group. After the ultrasonic localization of spinous process space， the single subarachnoid puncture through median approach was performed in all the patients， and the successful puncture was determined by the outflow or drawn-out of cerebrospinal fluid in the spinal anesthesia needle.The patients in tradition group were treated with the traditional needle-through-needle puncture technique （a 16 G epidural puncture needle was used to guide the puncture，and a 25 G pencil-point side-hole spinal needle was applied）；the patients in modification group were treated with the modified needle-through-needle puncture technique （a 20 G injection needle was used to break the skin directly for guidance， and a 25 G pencil-point side-hole spinal needle was applied）. The once-puncture success rates，twice-puncture success rates，first-skin-attempt puncture success rates， and twice-skin-attempt puncture success rates， puncture time， patients’ satisfaction rates，onset-time of anesthesia，assessment of anesthesia block， fixation-time of anesthesia， satisfaction of surgeon for muscle relaxation， operation time， residence time in PACU， immediate adverse reactions during anesthesia， and adverse reactions within 48 h after operation of the patients in two groups were compared. Results All the patients had successful punctures. Compared with tradition group， the once-puncture success rate， twice-puncture success rate， first-skin-attempt puncture success rate， and twice-skin-attempt success rate of the patients in modification group were increased （P<0.01），the puncture time was shorter （P<0.01）， the patients’ satisfaction rate was increased （P<0.01）， the onset-time of anesthesia was shortened（P<0.01），the fixation-time of anesthesia block was shortened（P<0.01）， the satisfaction rate of the surgeon was increased （P<0.01），the mean arterial pressure（MAP） and heart rater（HR） of the patients 10 min after anesthsia and 10 min after operation were increased（P<0.05）.Compared with tradiation group， the incidence of immediate adverse reactions during anesthesia， and the incidence of adverse reactions within 48 h after operation of the patients in modification group had no significant differences （P>0.05）. Conclusion In the elderly patients underwent unilateral total hip arthroplasty， the single isospecific gravity spinal anesthesia under non-visual conditions by the modified needle-through-needle puncture technique can significantly shorten the number of punctures and puncture time，and has higher puncture success rate.

Key words: Spinal anesthesia, Modified needle-through-needle puncture technique, Ultrasonic examination, Arthroplasty, Total hip joint