腰椎穿刺・硬膜外留置：超音波で外傷性穿刺

エコーを用いることで、穿刺やカテーテル留置失敗や外傷性穿刺リスク減少
穿刺回数、redirection数減少


Ultrasound imaging for lumbar punctures and epidural catheterisations: systematic review and meta-analysis
BMJ 2013; 346 
doi: http://dx.doi.org/10.1136/bmj.f1720 (Published 26 March 2013)
Cite this as: BMJ 2013;346:f1720

ランダム化トライアル
1134名、１４研究（超音波割り付け群 674、対照群 660)
脊椎穿刺 5研究、硬膜外カテーテル　9研究

失敗率

超音波群 6/624
対照群 44/610 (リスク比 0.21 (95% 信頼区間 0.10 to 0.43), P<0 .001="" p="">

腰椎穿刺・硬膜外のサブグループ解析でもリスク減少は同様 　 (リスク比 0.19 (0.07 to 0.56), P=0.002)、0.23 (0.09 to 0.60), P=0.003)

超音波画像は、外傷性穿刺リスク有意減少　(リスク比 0.27 (0.11 to 0.67), P=0.005)
穿刺行為数増加  (差平均 −0.44 (−0.64 to −0.24), P<0 .001="" p="" redirection="" to="">

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手技を知りたいので、上記論文引用先

Stiffler KA, Jwayyed S, Wilber ST, Robinson A. The use of ultrasound to identify pertinent landmarks for lumbar puncture. Am J Emerg Med2007;25:331-4.

Arzola C, Davies S, Rofaeel A, Carvalho JCA. Ultrasound using the transverse approach to the lumbar spine provides reliable landmarks for labor epidurals. Anesth Analg2007;104:1188-92 (full text)

Figure 1. Ultrasound imaging in the transverse approach shows the spinous process as a hyperechoic signal (bright) immediately underneath the skin, continued as a vertical triangular hypoechoic (dark) acoustic shadow. This image is used to mark the midline of the spine.

（横断アプローチで、椎体をマーク）

 
 Figure 2. Ultrasound imaging in the transverse approach shows the vertebral body, dural sac, ligamentum flavum, and dura mater. This image is used to mark the intervertebral space.

( 横断アプローチで、椎体、硬膜嚢、黄色靱帯、硬膜）

Figure 3. Ultrasound imaging shows measurements with the built-in caliper. Ultrasound depth (UD, in cm) is the expected puncture depth to reach the epidural space from the skin to the inner surface of the ligamentum flavum–dura mater unit.

(皮膚から黄色靱帯・硬膜内部表面までの深さを予測）

Tran D, Kamani AA, Al-Attas E, Lessoway VA, Massey S, Rohling RN. Single-operator real-time ultrasound-guidance to aim and insert a lumbar epidural needle. Can J Anaesth2010;57:313-21.