Application Of Orbital Combined Spinal And Epidural Kit In The Anesthesia Of Cesarean Section

To compare the safety and availability between a new orbital combined spinal and epidural(CES)needle,needle-beside-needle(NBN)technique and traditionalTophy needle,needle-through-needle(NTN)technique during cesarean section,we conducted this prospective,randomized controlled study.There were 115 healthy parturients(American society of anesthesiologists,ASA physical status I-II,age 18-35 years)scheduled for elective cesarean section included in the study.They were randomized to receive NBN(n=58)or NTN technique(n=57)in combined epidural/spinal anesthesia(CSEA)using random number table.A rapid fluid preload with Ringer's lactate were administered at 800 mL/h after reaching the operating room.Oxygen was administered via a nasal cannula at a flow rate of 3 L/min.Electrocardiogram,non-invasive blood pressure and pulse oximetry were monitored and recorded.All neuraxial blocks were implemented following strict aseptic technique,in the right lateral position.In the NTN group,traditional Tuohy needle was used to perform CSEA.After confirming the epidural needle insert,spinal anesthesia was performed with 2-3ml 0.5% hyperbaric ropivacaine(2.0 ml 0.75% ropivacaine + 1.0ml 10% glucose solution)according to height of patients.After spinal needle removal,the epidural catheter was inserted into the epidural space and fastened after removing the epidural needle.In the NBN group,we performed CSE using NBN Kit(AS-E/S).The orbital epidural needle was inserted in the L3-4 interspace,and then a catheter was introduced through the lumen.Spinal anesthesia methods were conducted in the same approach as the NTN group.After fastening of the catheter to the back,the patients were turned supine for surgery.A blind observer recorded the drug dosages,hemodynamic indexes including blood pressure and heart rate,procedure time,interval from spinal anesthesia to settle supine position,epidural and spinal puncture counts,maximum sensory levels,adverse events including intrathecal and intravascular catheter,unintentional dural puncture with epidural needle,extradural hemorrhage,paresthesia during procedure;hypotension during the surgery;lower limbs paresthesia,lumbar pain,headache,nausea/vomiting after the surgery;as well as evaluation of the anesthetist and patients on the two techniques using visual analogue scale(VAS).The results show that: Procedure time(339.71±52.78 vs 364.56±79.07,P=0.049)and duration from spinal anesthesia to settle supine position(103.76±34.52 vs 142.30±32.57,P<0.001)in NBN group were less than NTN group.There were no significant difference regarding the satisfactions of patients about the two techniques,while the anesthetist's satisfaction was higher in NBN group(1[0,1.25] vs 1[1,2],P=0.006).In addition,the spinal needle was more stable in the NBN group compared with NTN group(0[0,0] vs 1[0,2],P<0.001).While there were no statistically significant adverse events and requirement of anaesthetics between the two groups,and no differences were found in maximum sensory level,count of intraspinal punctures and failures on first attempt.After careful analysis,conclusions are as follows:(1)The higher stability of spinal needle highlighted the superior performance of NBN technique compared with traditional NTN technique during cesarean section,which may attribute to avoid potential spinal cord injury during spinal anesthesia.(2)Even though the adverse events associated with CSEA were not significantly decreased,with less procedure time and interval from spinal anesthesia to settle supine position,this new NBN technique may be appreciated as the current better equipment.(3)Higher satisfaction of anesthetists in NBN group indicate that this technique is more convenient for clinical practice.