Elbow long - term epidural analgesia how to hit subcutaneous tunnel

According to the conventional epidural anesthesia surgery method for choosing and operation, select the puncture point in the space between the high waist and low bosom, use an adrenaline of 1% lidocaine anesthesia puncture point (all) the surrounding skin and subcutaneous tissue, crosscutting mouth 1 cm deep fascia, epidural needles incision, identify the epidural space according to the standard technology, Insert the special epidural catheter into the epidural space through the epidural needle, up to the cephalic direction at least 10cm (if the catheter is too soft during operation, the surgeon can also insert a guide wire inside the special epidural catheter to increase the hardness, so that the catheter can enter).

Then, remove the epidural needle from the epidural catheter (if there is a reinforcing guide wire in the epidural catheter, the guide wire should be pulled out), and clamp the epidural catheter near the puncture point with toothless hemostatic forceps to prevent leakage of fluid. At the 10 cm from the side of the puncture point (point to thoracic above, about an epidural needle length), using the above method after anesthesia cut a 5 mm small incision (second incision), from the incision with epidural needles through the skin to all the first mouth, epidural catheter inserted into the epidural backward from epidural needlepoint beard needle, needle from the tail, and then exit the epidural needle, Pull the epidural catheter completely through the second incision (be careful not to knot the catheter when pulling).

Beside a second incision within a radius of 2 to 10 cm, to choose a local tissue is thick place for place of subcutaneous embedding pump pump body parts (3) incision, cut a long 2.5 cm of incision there, beside from the incision subcutaneous with blunt (e.g., surgical scissors back) anatomy of the flat cut into 2-3 cm into a bag shape, to flat into the analgesia pump pump body is advisable. Then the epidural catheter was threaded to the third incision in the above method, and the epidural catheter was clamped near the incision with toothless hemostatic forceps (at this time, the hemostatic forceps at the first orifice was released). The 2.5-cm catheter was kept to protrude the incision, and the rest of the catheter was cut off. The screw of the pump body was inserted into the external catheter about 2cm from the tail end. Then epidural tube set into the pump body outlet tube core, fit for at least 5 mm (it is advisable to try to pull off not easily), then the screw on the pipe with the pump body outlet screw tight, loosen the hemostatic forceps, smooth pipe, 2 ml with physiological saline injection, to observe the watertight after confirm the tube connected to the pump body, is not knot, then pump body flat into the subcutaneous bag has been completed, Check and confirm that the catheter is not exposed and knotted (if the catheter left is too long, the catheter can be put into a ring and flat under the fascia, pay attention to not knotted), suture the incision as usual, and place the drainage tube (remove the drainage tube and remove the suture at the usual time).

After the above process is completed, analgesics can be injected subcutaneously. Steps: Use the thumb and index finger to touch the edge of the pump body on both sides of the patient's skin, determine the center point of the pump body, and make vertical subcutaneous injection from there. The depth of injection puncture is appropriate when the injection needle tip just touches the bottom of the pump body, and the injection intensity is not too strong, and the force should be moderate. The injection needle can be a non-injurious injection needle or a 25G (5#) disposable scalp needle provided by the manufacturer.

In addition, patients may consider taking intravenous antibiotics once to prevent infection.

Subcutaneous threading epidural catheter to submerged pump, in addition to the above method, can also be without epidural needle, needle, but with the tunnel from the first mouth all play a subcutaneous tunnel to a second incision position, then epidural catheter mouth set of about 5 mm into the end of a tunnel needle push press tightly, pull the catheter with tunnel needle through the tunnel to the next notch, and use the same method to the third incision.

Due to the different physical conditions of the patients, the location of the buried pump is also different. The location is far away from the first mouth. It is necessary to add one or two small incisions appropriately, and repeat the above process of penetrating the epidural tube to lead the catheter to the buried pump point. The location is closer to the first mouth, or the second incision can be directly cut larger, and the subcutaneous bag is made next to the second incision. The epidural catheter is directly connected to the embedded pump body from the second incision to reduce the incision.

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