Discussion On Drainage Of Cerebrospinal Fluid With Different Approach On Combined Spinal-epidural Anesthesia

Objective:To investigate the effect of different approaches on the drainage of cerebrospinal fluid in patients with spinal-epidural anesthesia and the causes of cerebrospinal fluid drainage difficulties.The effects of different approaches on the incidence of low back pain after combined spinal-epidural anesthesia were also investigated.Method:From April 2015 to March 2017,we selected patients who underwent surgery such as lower abdomen,pelvis and lower extremity in our hospital.In the past,there were 130 patients with no history of back pain,no spinal deformity and no spinal anesthesia,and 130 patients with well-proportioned ASA grade Ⅰ ~ Ⅱ were randomly divided into two groups: the median approach group(control group)and the lateral approach group(Experimental group),65 cases in each group.Choose L3-4 space for epidural puncture.After puncture was successful,observe and record puncturing time,one-time success rate of epidural puncture and lumbar puncture success rate and epidural puncture and lumbar puncture at the time of the incidence of neurological abnormalities;also observed one-time drainage of cerebrospinal fluid,and will It is divided into two categories:(1)can not drain cerebrospinal fluid;(2)cerebrospinal fluid drainage is poor.We compared the drainage of cerebrospinal fluid with spinal anesthesia by two different approaches.Follow-up was followed up for the incidence of postoperative low back pain at 2 days,7 days and 6 weeks after operation.Result:The puncturing time of the middle approach group and the lateral approach group was larger than that of the lateral approach group(P <0.05).Compared with the two approaches,lateral approach could significantly improve the epidural space(P <0.05).The one-off success rate of lumbar puncture in the lateral approach group was significantly higher than that in the median approach group(P <0.05).However,in the two groups,the success rate of lumbar puncture There was no significant difference in the occurrence of external peritoneal catheterization and neurological abnormalities in spinal anesthesia(P> 0.05).The incidence of various types of cerebrospinal fluid drainage in the median approach group was significantly higher than that in the median(P <0.05).Compared with the two groups,the incidence of low back pain at 7 days and 6 weeks after operation in the middle approach group was significantly higher than that in the side approach group at 7 days and 6 weeks after operation Incidence(P <0.05).Conclusion: CSEA lateral approach has clinically proven safe.Side of the road puncture with epidural puncture and lumbar puncture,a one-time success rate is not easy to produce neurological disorders,low incidence of cerebrospinal fluid drainage difficulties,low incidence of postoperative low back pain,it is worth to promote the clinical application.