How to make a subcutaneous tunnel for long-term epidural analgesia

According to the conventional epidural anesthesia operation method selection and operation, choose the puncture point in the space between the high waist and the low chest, and use 1% lidocaine containing epidural to local anesthetize the puncture point (the first incision) Surrounding skin and subcutaneous tissue, a transverse incision of 1 cm deep into the fascia, an epidural needle was inserted through the incision, and the epidural space was identified according to standard techniques. Enter at least 10cm in the cephalad direction (if the operator feels that the catheter is too soft during operation, he can also insert a guide wire into the epidural special catheter to increase the hardness so that the catheter can enter).

Then, remove the epidural needle on the epidural catheter (there is a reinforced guide wire in the epidural catheter, and the guide wire should also be pulled out), and clamp the epidural catheter near the puncture point with toothless hemostatic forceps. Prevent liquid leakage. At 10cm from the side of the puncture site (pointing above the thorax, about the length of an epidural needle), a small 5mm incision (second incision) was made after local anesthesia using the above method, and an epidural needle was used to pierce the incision from this incision. Passing subcutaneously to the first incision, the epidural catheter is inserted into the epidural needle from the tip of the epidural needle in the reverse direction, pierced through the needle tail, and then withdrawn from the epidural needle, and the epidural catheter is completely removed from the second incision. Pull out (be careful not to kink the catheter when pulling the catheter).

Within a radius of 2 to 10cm next to the second incision, choose a place with thicker local tissue as the part where the pump body is subcutaneously embedded (the third incision), and cut an incision about 2.5cm long at the incision. Use a blunt instrument (such as the back of surgical scissors) to dissect and incise 2-3cm into a bag-shaped subcutaneously to the side, so that it can be placed in the analgesic pump body flatly. Then guide the epidural catheter to the third incision according to the method described above, and clamp the epidural catheter near the incision with toothless hemostatic forceps (at this time, the hemostatic forceps at the first incision is released), keep it About 2.5cm of the catheter protrudes from the incision, the rest of the catheter is cut off and removed, the pump body screw is inserted into the hard outer catheter from the tail end for about 2cm, and then the epidural nozzle is inserted into the pump body outlet metal tube core, at least 5mm (to test It is better to pull it off easily), then tighten the screw on the catheter with the thread at the outlet of the pump body, loosen the hemostatic forceps to make the catheter unobstructed, try to inject 2ml of normal saline, and observe to confirm that the catheter and the pump body do not leak after connecting. Do not kink, then put the pump body flat into the prepared subcutaneous bag, check and confirm that the catheter is not exposed and kinked (if the remaining catheter is too long, the catheter can be placed in a circular shape under the fascia, pay attention to Do not kink), suture the incision as usual, and place the drainage tube (remove the drainage tube and remove the sutures at the usual time).

After the above process is completed, the pain reliever can be injected subcutaneously. Steps: Use the thumb and index finger to touch the edges of the pump body on the patient's skin, determine the center point of the pump body, and perform vertical subcutaneous injection from there. Fierce, moderate effort. The injection needle can use the non-invasive injection needle provided by the manufacturer or a 25G (5#) disposable scalp needle.

In addition, patients may consider a single dose of intravenous antibiotics to prevent infection.

Pass the epidural catheter subcutaneously to the buried pump. In addition to the above method, the epidural needle can also be used, but a tunnel needle can be used to make a subcutaneous tunnel from the first incision to the second incision position, and then the dura Insert the outer catheter port into the end of the tunnel needle about 5mm and push it tightly. Use the tunnel needle to pull the catheter to the second incision through the tunnel, and use the same method to lead to the third incision.

Due to the different physical conditions of the patients, the location of the buried pump is also different. If the location is farther away from the first incision, one or two small incisions should be appropriately added, and the above process of penetrating the epidural tube can be repeated to guide the catheter to the buried pump. pump point. If the location is closer to the first incision, the second incision can be directly cut larger, a subcutaneous bag is made beside the second incision, and the epidural catheter is directly connected to the pump body from the second incision to reduce the incision.

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