课件：鞘内药物输注治疗慢性疼痛.pptVIP

THANK YOU SUCCESS * * 可编辑 * Use a shallow-angle (approximately 30?), paramedian oblique needle insertion angle and trajectory. The entry point of the needle into the skin (or fascia if the needle insertion is performed through an open incision) should be approximately 1 to 1 ? vertebral levels below the interlaminar space selected for dural puncture and 2 cm lateral to the midline, on the side of the intended pump pocket. The needle stylet should be kept in place during dural puncture, keeping the beveled needle tip oriented parallel to the longitudinal dural fibers. A return of CSF through the needle signals entry into the subarachnoid space. * Using fluoroscopy, orient the needle bevel parallel to the dural fibers and insert the 15-gauge spinal needle. When inserting the needle, a shallow, paramedian oblique insertion (approximately 30?) is recommended. In the paramedian oblique placement, the site of the needle entry through the skin is lateral to the spinous processes, approximately 1-1 1/2 vertebral levels below the interlaminar space through which the needle will pass. Under fluoroscopic monitoring, the lateral coordinate for skin entry is approximately parallel to the vertebral pedicle; the imaging target for the needle tip is the midline of the selected interlaminar space. Insert the needle tip at the L2-3 or L3-4 level unless the patient’s anatomy, disease process, previous surgery or other unusual circumstances dictate otherwise. * Repeated from previous slide, orient the needle bevel cephalad, remove the stylet and thread the distal tip of the catheter through the needle to the desired location. When the tip of the catheter reaches the curved point of the needle, a slight increase in advancement pressure will be noted and the most distal centimeter marking will be located at the needle hub. Repeated from previous slide, Make certain the catheter guide wire is seated completely, with its hub against the proximal end of the catheter. The g