Новый способ фиксации эпидурального катетера при проведении спинально-эпидуральной анестезии в травматологии

Abstract

Purpose. To assess the advantage of a new method of insertion and fixation of an epidural catheter (EC) in the subcutaneous canal using a modified spinal needle (MSN) when performing combined two-level spinal-epidural anesthesia (CTSEA) in comparison with the standard method of fixing EC in elderly and senile patients during bone fracture repair of the lower extremity. Material. We analyzed 118 cases of CTSEA during trauma surgery in elderly and senile patients. The patients were divided into two groups. The first group (control) consisted of 63 patients who, during the course of CTSEA, had an epidural catheter fixed to the skin by a standard method with an adhesive patch. In the second group (experimental), 55 patients underwent EC which were fixed in the subcutaneous canal using a modified spinal needle. Result. In the study group, no internal dislocation of EC was noted. In the same group, compared with the comparison group, there were 15.9 % fewer cases of severe dislocation in which there is a risk of deterioration in the quality of anesthesia; external dislocation in which there was a threat of EC falling out oc-curred 12 % less; EC fell out of the epidural space (ES) 2.6 times less frequently. Conclusion. A new method of conducting EC in the subcutaneous canal using MSN promotes reliable fixation of the catheter, creates conditions that prevent its dislocation and loss from the ES, thereby allowing an effective and long-term postoperative analgesia. The method of fixation of the catheter does not lead to an increase in the cost of the CTSEA technique.