METHOD FOR CHOOSING METHOD FOR FIXING EPIDURAL CATHETER DEPENDING ON ANATOMICAL FEATURES OF SURFACE OF LUMBAR REGION Russian patent published in 2023 - IPC A61M19/00 A61B17/34 

FIELD: anaesthesiology; intensive care.

SUBSTANCE: invention is intended for use in fixing an epidural catheter in the lumbar region of a patient. Before installing the catheter in the epidural space, to select the method of its fixation, the shape of the surface of the epidural access area is measured, for this purpose using the first millimeter ruler if the patient has ʌ shape of the surface of the lumbar region, characterized by a depression in the midline and an elevation to the right and left of midline, the distance is measured between the most elevated surfaces located to the right and left of the midline along a line located in the horizontal plane, after which, using a second millimeter ruler, the distance is measured from the line passing between the most elevated points on the surface of the lumbar region, located to the right and left of the midline, placing the second ruler perpendicular to the first ruler in the sagittal plane so that the proximal end of the ruler with the 0 mm mark touches the skin surface in the projection of the spinous processes. Then the two sizes obtained are noted, and if the first size obtained when measured with the first ruler is more than 7 mm, and the second size obtained when measured with the second ruler is less than 55 mm, then a conclusion is made about an absolute contraindication for attaching the epidural catheter with a fixing device, in which the size of the dense area in diameter will be 55 mm and an absolute indication for fixing the epidural catheter by tunneling in the subcutaneous canal. If the first size is more than 7 mm, and the second size is more than 55 mm, then a conclusion is made about a relative contraindication for fixing the epidural catheter with a fixing device, in which the size of the dense area in diameter will be 55 mm, and a relative indication for fixing the epidural catheter using the tunneling method in the subcutaneous channel. If the first size is equal to or less than 7 mm, and the second size is more than 55 mm, then a conclusion is made about the relative indication for attaching the epidural catheter with a fixing device in which the size of the dense area in diameter will be 55 mm or by tunneling in the subcutaneous canal. If the patient has a V shape of the surface of the lumbar region, characterized by an elevation in the midline, the distance between the surface of the skin of the lumbar region at the site of epidural access and the level of the greatest elevation of the protruding spinous process above the surface of the lumbar region is measured with the first millimeter ruler, the ruler is placed in the sagittal plane parallel to the ascending spinous process so that the proximal end of the ruler with a 0 mm mark touches the surface of the skin next to the ascending spinous process of the vertebra, the second millimeter ruler is placed parallel to the surface of the skin of the lumbar region in a horizontal plane at the point of epidural access so that both rulers intersect at an angle 90°, the size at the point of intersection of both rulers on the first ruler is noted, and if the measured size is more than 7 mm, then a conclusion is made about a relative contraindication for fixing the epidural catheter with a fixing device, regardless of the size of the dense section of the device and a relative indication for fixing the epidural catheter using the tunneling method subcutaneous channel. If the measured size is equal to or less than 7 mm, then a conclusion is made about the relative indication for securing the epidural catheter with a fixing device, regardless of the size of the dense portion of the device or the method of tunneling in the subcutaneous canal.

EFFECT: reduced risk of dislocation of the epidural catheter, which provides more effective epidural analgesia.

1 cl, 4 dwg, 12 ex