产妇硬脊膜穿刺后头痛的循证防治

目的探讨产妇硬脊膜穿刺后头痛(PDPH)的循证预防治疗措施。方法计算机检索Cochrane图书馆(2006年第3期)、MEDLINE(1980.1～2006.10)和中国生物医学文献数据库(1980.1～2006.10),收集关于产妇硬脊膜穿刺后头痛防治的系统评价、Meta分析和临床对照试验(RCT),并评价所获得的证据质量。结果共检索到2篇Cochrane系统评价,2篇Meta分析和9篇RCT。分析结果表明,硬膜外自体血液填充治疗疗效确切,体位、液体和药物治疗对产妇PDPH的发生率和严重性无明显影响。选择适当腰麻穿针刺和穿刺技术能有效降低产妇PDPH的发生,而蛛网膜下腔注入生理盐水和置管预防技术的价值尚有待进一步验证。结论硬膜外自体血液填充对产妇的PDPH具有确切的治疗作用,选择适当腰麻穿刺针和穿刺技术能有效预防产妇PDPH的发生。     

Diagnostic lumbar puncture. Comparative study between 22–gauge pencil point and sharp bevel needle

Post-lumbar puncture headache is a frequent clinical problem. Needle design is expected to reduce post-puncture headache. In this study, we compared two different lumbar puncture needle designs in diagnostic lumbar puncture and analysed post-dural puncture headache (PDPH) and social and economical harm associated with the diagnostic lumbar puncture procedure. This prospective, controlled study consisted of 80 consecutive adult patients requiring elective diagnostic lumbar puncture due to various neurological symptoms. Lumbar puncture was completed either with Spinocan 22 G sharp bevel needle or Whitacre 22G pencil point needle. Patients were asked about previous headache symptoms and pain provoked by puncture. One week after the lumbar puncture all patients were interviewed by telephone and occurrence and type of headache, headache intensity, medication and frequency of impairment in activities of daily living were asked. Need for epidural blood patch was also recorded. Thirty-three of 78 (42%) patients experienced headache after diagnostic lumbar puncture and in 26 (33%) the headache could be classified as PDPH. There were no statistically significant differences between needle types in the frequency of common headache, PDPH, puncture pain intensity, need for epidural blood patch or sick leave. Also, there were no other complications except local back pain or headache. In this study, the needle design did not affect the frequency of PDPH. Also, PDPH was common, occurring in 33% cases and caused a considerable amount of disturbance in daily activities. Seeking help for this condition was insufficient and only part of these PDPH patients were treated with epidural blood patch.     

Effect of preloading epidural space with normal saline on the incidence of complications of epidural catheter placement and spinal anesthesia for cesarean section

To evaluate the effect of preloading the epidural space with normal saline (NS) on the incidence of complications of epidural catheter placement and spinal anesthesia for cesarean section. Two hundred and ninety parturients at full term, who were scheduled for cesarean section under combined spinal–epidural anesthesia were randomly divided into two groups: group control (I) and group NS (II). The epidural puncture was performed at the estimated L_3–4 interspace with a Tuohy needle attached to a 5 ml syringe. Loss of resistance to air was used to identify the epidural space. In group I no fluid was injected into the epidural space before insertion of the catheter; while in group II NS 5 ml was injected into the epidural space before catheter insertion. The incidence of blood vessel trauma and paraesthesia were evaluated. The effect of spinal anesthesia was evaluated. Blood vessel trauma in group II was significantly lower than in group I, P < 0.05. However, the incidence of paraesthesia was similar between the two groups, P > 0.05. Preloading the epidural space with NS can decrease the incidence of clinically apparent injury to blood vessels during epidural catheter placement, and can improve the effects of spinal analgesia, but does not reduce the incidence of paraesthesia.     

Incidence of post-dural puncture headache in research volunteers

Objective.— To determine the frequency and risk factors of post‐dural puncture headache (PDPH) in research volunteers. Background.— Despite increasing interest in measuring cerebrospinal fluid (CSF) biomarkers to investigate disease pathogenesis and diagnosis, previous case series have evaluated lumbar puncture (LP) safety only in clinical care. PDPH is a common complication after LP. Methods.— We determined the frequency of PDPH in neurologically unselected HIV seropositive and seronegative adults volunteering for research, as well as the variables associated with the development of PDPH. Variables studied were body mass index (BMI), HIV serostatus, volume of CSF removed, number of previous LPs, use of pre‐medication, LP position, lumbar space, number of needle passes, whether or not aspiration was used, CSF white blood cell counts, CSF red blood cell counts, CD4 count, CD4 nadir, CSF HIV viral load, plasma HIV viral load, and race. Results.— Of 675 LPs performed over 1 year, headache developed in 38 (5.6%; 95% CI 4.2, 7.1). Most PDPH (92%) resolved spontaneously or with conservative medical management; 3 required epidural blood patch. Greater headache risk was associated with lower BMI (BMI ≤25 vs >25) (OR 3.3; CI 95% 1.5, 7.0; P = .001) and less prior LP experience (previous LPs ≤2 vs >2) (OR 2.1; CI 95% 1.1, 4.1; P = .03). PDPH was not significantly (P > .05) related to HIV serostatus, CSF volume, or gender. Conclusion.— In this study, where tolerance to risk was low because LPs were done for research rather than clinical purposes and healthy controls were included, adverse effects were mild and self‐limited.     

Cerebral venous thrombosis after epidural blood patch: coincidence or causal relation? A case report and review of the literature

We report on a female patient who developed post-dural puncture headache (PDPH) after epidural analgesia for delivery. Treatment with epidural blood patch led to complete headache remission and the patient was discharged. Two days later the patient was readmitted with hemihypaesthesia and mild hemiparesis of the right side. Magnetic resonance imaging showed a small left parietal cortical haemorrhage probably following cerebral venous thrombosis (CVT). Coagulation screening detected heterozygous Factor V mutation. Headache is a common symptom of PDPH and CVT. Review of the literature revealed five patients in puerperal state, who developed CVT in close temporal relationship after blood patch treatment for PDPH . Change of headache character with loss of postural influence was reported frequently before diagnosis of CVT was confirmed. These findings may indicate a causal relationship.     

High-flow oxygen and pro-serotonin agents for non-interventional treatment of post-dural-puncture headache

ObjectivePost dural puncture headache (PDPH) is a common complication in patients following diagnostic or therapeutic lumbar puncture, procedures requiring epidural access, and spinal surgery. Epidural blood patch (EBP), the gold standard for the treatment of this pathology requires training not provided to emergency physicians. In addition, the presence of concomitant pathology and abnormal laboratory values are contraindications to perform EBP. In presence of these limitations, we sought for a non-interventional management of PDPH utilizing high-flow oxygen and pro-serotonin agents. We reviewed the mechanism of action of this therapyMethodsTo illustrate our proposal, we report a series of twelve consecutive patients with PDPH treated with high-flow oxygen therapy at 12 L/min via a non-rebreathing mask and intravenous metoclopramide.ResultsAll patients were treated with this conservative therapy, no adverse reactions were observed. After the intervention, the headache resolved without further indications for PDPH.ConclusionOur series suggests that combining high-flow oxygen and pro-serotonin agents such metoclopramide in the ED might be a feasible option as effective as the invasive methods used in treating PDPH. This therapy appears to be efficient and to minimize risk, cost and side effects. It presents an easily accessible alternative that should be considered when PDPH is not a viable option.     

Post‐Dural Puncture Headache: Part I Diagnosis,Epidemiology, Etiology,and Pathophysiology

(Headache 2010;50:1144‐1152) Post‐dural puncture headache (PDPH) is a frequent complication of dural puncture whether performed for diagnostic purposes or accidentally, as a complication of anesthesia. Because both procedures are common, clinicians interested in headache should be familiar with this entity. The differential diagnosis of PDPH is broad and includes other complications of dural puncture as well as headaches attributable to the condition which lead to the procedure. The patterns of development of PDPH depend on a number of procedure‐ and nonprocedure‐related risk factors. Knowledge of procedure‐related factors supports interventions designed to reduce the incidence of PDPH. Finally, despite best preventive efforts, PDPH may still occur and be associated with significant morbidity. Therefore, it is important to know the management and prognosis of this disorder. In this review, we will highlight diagnosis and clinical characteristics of PDPH, differential diagnosis, frequency, and risk factors as well as pathophysiology of PDPH.     

硬膜外预充液对腰硬联合阻滞剖宫产术患者硬膜外置管血管损伤及腰麻效果的影响

目的 观察硬膜外预充液预防剖宫产术患者硬膜外导管致硬膜外血管损伤及腰麻效果的影响.方法 将180例单胎足月妊娠拟在腰硬联合麻醉下行剖宫产术的产妇,按随机数字表法分为3组,每组60例.3组产妇均取左侧卧位,L2-3椎间隙行腰硬联合穿刺.硬膜外穿刺成功后将脊麻针穿过硬膜外针内腔行蛛网膜下隙穿刺,见脑脊液回流后,注入0.75％左布比卡因2.0 mL,拔出腰麻针.Ⅰ组产妇硬膜外置管前在硬膜外腔注入生理盐水5 mL;Ⅱ组产妇硬膜外置管前在硬膜外腔注入含麻黄素15 mg的生理盐水5 mL;Ⅲ组产妇硬膜外腔直接置入导管.记录3组产妇血管损伤发生率,观察麻醉注药前(T0),经穿刺针注药液后2 min(T1),5 min(T2)HR、SBP、DBP的变化,以及采用针刺法测定注药后5、10 min时的感觉阻滞平面.结果 Ⅰ、Ⅱ、Ⅲ组血管损伤发生率分别为3.3％、1.6％及13.3％,Ⅲ组血管损伤发生率明显高于Ⅰ组和Ⅱ组(均P＜0.05),Ⅰ组和Ⅱ组比较差异无统计学意义(P＞0.05).3组产妇T1及T2的SBP较T0有明显的下降(均P＜0.05),3组间比较差异均无统计学意义(均P＞0.05).Ⅰ、Ⅱ组感觉阻滞平面较Ⅲ组明显升高(P＜0.05),Ⅰ、Ⅱ组注药后感觉阻滞平面比较差异无统计学意义(P＞0.05).结论 腰硬联合麻醉剖宫产产妇在硬膜外预充少许液体,可以预防硬膜外导管置入时损伤血管,提高剖宫产产妇腰硬联合阻滞麻醉的安全性,同时还可改善腰麻的效果.     

Combined Ultrasound and Nerve Stimulation-Guided Thoracic Epidural Catheter Placement for Analgesia Following Anterior Spine Fusion in Scoliosis

Anterior spine fusion by thoracotomy is indicated for the treatment of idiopathic scoliosis. Although epidural (EP) analgesia represents the most effective way to provide adequate analgesia after thoracotomy, scoliosis patients have substantial anatomic variations that make EP catheter placement more difficult and often contraindicated. This case report describes a safe, effective technique for placing a thoracic EP catheter in a young patient undergoing anterior spine fusion surgery by thoracotomy. The procedure was guided by both ultrasound (US) and electrical stimulation of the Tuohy needle and catheter. The combination of US and nerve stimulation in this setting may be associated with easier, potentially safer, and more accurate insertion.     

The 90% Effective Dose of Sufentanil for Epidural Analgesia in the Early First Stage of Labor: A Double-blind,Sequential Dose-Finding Study

PurposeEpidural analgesia in the latent phase of the first stage of labor has been recognized and accepted by anesthesiologists worldwide. However, there is no unified consensus on the exact dosage of sufentanil with the combination of ropivacaine in the induction of epidural analgesia in the early first stage of labor. In this sequential dose-finding study, the 90% effective dose (ED₉₀) of sufentanil for epidural administration in the early first stage of labor was estimated to minimize the adverse effects of using higher doses.MethodsForty parturients with cervical dilatation of 2 to 4 cm who requested epidural analgesia were enrolled in this study. Parturients received 15 mL of a combination of ropivacaine 13 mg and the test dose of sufentanil. The initial dose of sufentanil in epidural administration was 1 μg, and the dose of sufentanil for the next parturient was based on the response of the preceding participant as per a biased coin up-and-down design. The primary outcome was the dose of sufentanil that resulted in successful epidural administration by maintaining the parturients’ visual analog scale scores at ≤30 mm in the first 15, 30, and 45 minutes of induction. The ED₉₀ and 95% CIs were estimated using isotonic regression methods and bootstrapping.FindingsThe estimated ED₉₀ of sufentanil in epidural administration in the early first stage of labor was 1.91 μg (95% CI, 1.82–2.35 μg) in this sequential dose-finding study.ImplicationsSufentanil at a dosage of 2 μg is recommended for the administration of epidural analgesia in parturients in the early first stage of labor. ChiCTR.org.cn identifier: 1900021683.     

Frovatriptan for the prevention of postdural puncture headache

Bussone G, Tullo V, d'Onofrio F, Petretta V, Curone M, Frediani F, Tonini C & Omboni S. Frovatriptan for the prevention of postdural puncture headache. Cephalalgia 2007; 27:809–813. London. ISSN 0333-1024
Efficacy of 5-day treatment with oral frovatriptan 2.5 mg/die for the prophylaxis of post-dural puncture headache (PDPH) was tested in 50 in-patients. A mild headache occurred in 7 (14%) patients for a total of 9 days (p < 0.01 vs. no-PDPH). Most episodes of PDPH occurred in the first days of treatment (only 1 patient had headache at dismissal): 5 patients had only 1 episode, while 2 had headache for 2 consecutive days. No other symptoms were recorded. Occurrence of PDPH in a subgroup of 6 (12%) patients previously submitted to a diagnostic lumbar puncture was also examined: 4 of them reported a PDPH on the previous lumbar puncture in absence of triptans. In only 1 of these 4 patients PDPH recurred under treatment with frovatriptan. In conclusion, our non-randomized open-label study suggests efficacy of oral frovatriptan for PDPH prevention. These results need to be confirmed in a randomized, controlled, double-blind study.     

Comparison of post-dural puncture headache and low back pain between 23 and 25 gauge Quincke spinal needles in patients over 60 years: randomized, double-blind controlled trial

Background

Even though the use of a 25 gauge or smaller Quincke needle is recommended for spinal anesthesia to reduce post-dural puncture headache in Korea, lumbar puncture in older patients using a 25 gauge or smaller Quincke needle can be difficult. However, most previous studies concerning post-dural puncture headache have chosen children, parturients, and young adults as study participants.

Objectives

The study compared post-dural puncture headache, post-operative back pain, and the number of lumbar puncture attempts using a 23 or 25 gauge Quincke needle for spinal anesthesia of Korean patients >60-years-of-age.

Design

Randomized, double-blinded controlled trial.

Participants

The 53 participants who underwent orthopedic surgery under spinal anesthesia were recruited by informed notices from December 2006 through August 2007 at a 200-bed general hospital located in Kyunggido. Inclusion criteria were an age >60 years, ASA I–II, and administration of patient controlled analgesia for the first 48 h post-operatively.

Methods

The 53 patients were randomly allocated to either the experimental (23 gauge Quincke needle) or control group (25 gauge Quincke needle). All patients had 24 h bed rest post-operatively. Post-dural puncture headache was assessed by the Dittmann Scale and post-operative back pain was assessed by a visual analogue scale at 24, 48, and 72 h post-operatively. The statistical methods included the Mann–Whitney U-test and Spearman correlation.

Results

There were no differences in post-dural puncture headache, and post-operative back pain at 24, 48, and 72 h post-operatively, and no differences in the number of lumbar punctures, with the 23 and 25 gauge Quincke needle. Forty-eight hour post-operative back pain was positively associated with the number of lumbar punctures (p = .036) and age (p = .040). There were no statistically significant associations among post-dural puncture headache, the number of lumbar punctures, and 48 h post-operative back pain. Pre-operative back pain was positively associated with 48 h post-operative back pain (p < .001).

Conclusions

The choice of a 23 or 25 gauge Quincke needle for spinal anesthesia has no significant influence on post-dural puncture headache and post-operative back pain for Korean patients greater than 60-years-of-age. The 23 gauge Quincke needle is an option for lumbar punctures in this patient population.     

Bilateral Subdural Hematoma after Inadvertent Dural Puncture during Epidural Analgesia

Background

Post-dural puncture headache (PDPH) is typically a benign complication of dural puncture that is clinically diagnosed. It commonly presents as a throbbing and positional headache that occurs 24-48 h after dural puncture. Subdural hematomas, if unrecognized, may occur as a rare and life-threatening complication of dural puncture.

Objectives

We aim to describe the clinical features and sequelae of a rare complication that may result as a consequence of inadvertent dural puncture that, if unrecognized, has the potential to become a life-threatening complication from a common procedure.

Case Report

We report the case of a previously healthy 17-year-old primigravida female who initially presented 4 days postpartum with clinical features and imaging studies consistent with PDPH. The patient's symptoms were unremitting, and within 4 weeks, she developed bilateral subdural hematoma. With prompt recognition and diagnosis, she was treated with conservative medical management and subsequently improved on follow-up.

Conclusion

Patients with unremitting PDPH should prompt the clinician to suspect the development of subdural hematoma as a potential life-threatening complication of an otherwise benign condition.     

The effects of colloid pre-loading on thromboelastography prior to caesarean delivery: hydroxyethyl starch 130/0.4 versus succinylated gelatine

This prospective, randomized, double-blind study compared the effects on thromboelastography (TEG) of pre-loading with two different colloid fluids prior to spinal anaesthesia for caesarean section. Healthy full-term parturients received either 500 ml 6% hydroxyethyl starch 130/0.4 (HES, n = 25) or 500 ml 4% succinylated gelatine (GEL, n = 25) prior to spinal anaesthesia. TEG parameters including reaction time (r-time), clot formation time (k-time), clot formation rate (α-angle) and maximum amplitude (MA) were measured immediately before and after pre-loading. Both groups had significantly shorter r-time and lower MA after pre-loading. The α-angle was significantly decreased after pre-loading with HES but not with GEL. No significant differences in k-time were induced pre-loading. In conclusion, pre-loading with HES or GEL was associated with a mild hypocoagulable effect in healthy parturients presenting for elective caesarean section; however, all TEG parameters in both groups remained within or very close to the normal range after pre-loading.     

纳布啡减少罗哌卡因用于硬膜外分娩镇痛的剂量:一项随机、双盲、对照研究

目的:探讨纳布啡混合罗哌卡因用于硬膜外分娩镇痛的作用.方法:选取2019年10月至2021年2月复旦大学附属妇产科医院收治的产妇104例.采用随机数字表将104例产妇随机分为纳布啡组(N组,n=52)和罗哌卡因组(L组,n=52).选择L2-3间隙进行硬膜外穿刺,穿刺成功并平卧后给予试验剂量.给药方法:N组,硬膜外注射...     

Needle‐Through‐Needle Technique in Lumbar Interlaminar Epidural Steroid Injection: A Case Report

When performing lumbar epidural steroid injection on obese patients, needle placement can be challenging due to the difficulty in estimating the appropriate needle length to utilize. Often times, the standard 3.5‐inch Tuohy needle is too short to reach its target. In our case report, a needle‐through‐needle technique was attempted in a lumbar interlaminar epidural steroid injection procedure after the initial needle fell short of the epidural space. To avoid removing the initial needle and restarting the procedure using a longer needle, a 20‐gauge 6‐inch Tuohy needle was inserted into the 17‐gauge 3.5‐inch Tuohy needle, successfully reaching the epidural space. This technique can facilitate quicker needle placement by avoiding the need for restarting the procedure with a longer needle. Thus, procedural time and radiation exposure may be decreased, as may patient discomfort from repeat needle insertions.     

简易针内针脊麻技术的临床应用

目的探讨简易针内针脊麻技术的成功率及安全性。方法拟行脐以下部位手术的患者200例,随机分为简易针内针穿刺组(SS组)和腰硬联合穿刺组(CS组)两组,每组100例,两组分别以8号注射针和硬膜外穿刺针作引导针进行脊麻穿刺,将退针并调整方向再进针视作再次穿刺,若三次不能成功即更换引导针。记录两组穿刺时间,分别比较两组穿刺成功率以及更换引导针的比例;记录穿刺过程中神经异感及硬膜外血管损伤发生情况;记录两组有无脊麻针折断、变形情况;随访患者腰痛及神经并发症发生情况。结果平均穿刺时间CS组明显长于SS组[(25.21±7.11)svs(33.71±11.52)s,(t=6.28,P<0.05)];两组一次、二次、三次穿刺成功率差异均无统计学意义(χ2分别=1.46、0.93、0.29,P均>0.05);SS组更换引导针的比例高于CS组(15.00%vs.3.00%,χ2=7.39,P<0.05);两组穿刺过程中神经异感差异无统计学意义(χ2=0.29,P>0.05);穿刺过程中无一例发生脊麻针折断、变形情况;穿刺过程中有酸胀不适感及术后腰痛患者CS组明显高于SS组(χ2分别=83.63、30.52,P均<0.05);两组均无神经并发症发生。结论简易针内针脊麻技术与腰硬联合穿刺技术具有相近穿刺成功率,且更简便快捷、损伤更小、安全性好;但对于穿刺困难患者或初学者,仍以硬膜外穿刺针引导穿刺为佳。     

Investigation of the Minimum Local Analgesic Concentration of Epidural Sufentanil Combined With Ropivacaine for Labor Analgesia

PurposeWorldwide, there are only few studies focusing on labor analgesia on the MLAC (minimum local analgesic concentration) or EC50 (median effective concentration) of sufentanil and ropivacaine. Therefore, we determine the MLAC or EC50 of sufentanil and ropivacaine for epidural analgesia by using an up–down sequential allocation and survey its adverse effect in a prospective blinded randomized trial.MethodsSixty nulliparous full-term parturients who required labor analgesia were recruited and randomly divided into the sufentanil and ropivacaine groups. The formulation was 25 μg sufentanil combined with 0.1% ropivacaine (added 0.9% normal saline to 75 ml). According to the response of a previous parturient, the dosage of sufentanil was increased or decreased by 5 μg in the sufetanil group; meanwhile, we also administrated an initial concentration of 0.1% ropivacaine combined with 22.5 μg sufentanil (added 0.9% normal saline to 75 ml) in the ropivacaine group. The concentration of ropivacaine was increased or decreased by 0.01% following the response of the previous parturient. The Brownlee up–down sequential allocation was used to estimate the MLAC of epidural ropivacaine and its 95% confidence intervals in labor analgesia.FindingsThere were no significant changes for the two groups, including for age, height weight, active stage, second stage of labor, and gestational weeks (P = 0.769, 0.900, 0.603, 0.441, 0.577, and 0.695, respectively). The VAS scores of the parturient decreased to varying degrees (P < 0.0001) after labor analgesia compared with VAS before labor analgesia, and the most effective analgesia was reached in 60 min. The EC50 dose of epidural ropivacaine combined with 0.3 μg/mL sufentanil was 0.09687%, and the 95% CI was 0.08944%~0.1043%. Five parturients had PONV, and the incidence rate was 16.7%; one parturient had pruritus, so the incidence rate was 3.3%. The EC50 dose of epidural sulfetanil combined with 0.1% ropivacaine was 18.76 μg with a 95% confidence interval of 13.5–24.48 μg. There were no significant differences in the active stage, second stage of labor, and maternal and fetal hemodynamic data between the two groups. Notably, the Apgar scores for 1 min and 5 min were 10 scores for almost all of these patients. There were no significant differences between the two groups for maternal and fetal side effects, which had very low incidence rates.ImplicationsThe MLAC of epidural sufentanil or ropivacaine could provide satisfactory and safe analgesia for parturients while having a low incidence rate of side effects.     

Continuous intrathecal fentanyl infusion for postoperative analgesia

Following inadvertent dural puncture during epidural catheter placement, a 20 gauge polyethylene catheter was placed in the intrathecal space, and continuous spinal anesthesia with hyperbaric bupivacaine was administered intraoperatively to supplement general anesthesia. Following surgery, a continuous intrathecal fentanyl infusion (0.2 mcg/kg/hr) was administered to provide postoperative analgesia. The child was awake and comfortable throughout this time and required no supplemental analgesic agents. Although epidural catheters are still our preferred method of analgesia, intrathecal fentanyl infusion is one alternative when inadvertent dural puncture occurs.     

减轻化疗患者留置针穿刺疼痛的方法

目的探讨减轻化疗患者留置针穿刺疼痛的方法。方法选择87例需化疗3d以上的肿瘤患者,在化疗的第1天、第2天、第3天分别以不同方法进行留置针穿刺。第1天以无菌生理盐水喷涂留置针软导管后穿刺（A法）;第2天以使用微量利多卡因喷涂留置针软导管后穿刺（B法）;第3天在进行心理暗示后使用微量利多卡因喷涂留置针软导管后穿刺（C法）。观察3种方法穿刺过程中患者疼痛的程度,并进行疼痛发生率的比较。结果 3种方法行留置针穿刺,患者疼痛的发生率分别为81.6%、40.2%、18.4%;C法较B法和A法在减轻患者穿刺疼痛方面效果更好,差异有统计学意义（P〈0.01）。结论微量利多卡因喷涂联合适当心理暗示能有效减轻患者对留置针穿刺的疼痛感,尤其适用于穿刺疼痛耐受差、心理惧怕的患者。