Prospective Examination of Epidural Catheter Insertion

1996 ◽  
Vol 84 (1) ◽  
pp. 88-93 ◽  
Author(s):  
Robert D'Angelo ◽  
Brenda L. Berkebile ◽  
J. C. Gerancher
Keyword(s):  
Epidural Analgesia ◽  
Epidural Catheter ◽  
Cesarean Delivery ◽  
Epidural Space ◽  
Local Anesthetic ◽  
Catheter Insertion ◽  
Labor And Delivery ◽  
Prolonged Labor ◽  
Epidural Catheters ◽  
Insertion Length

Background Although it is generally accepted that inserting epidural catheters 3-4 cm into the epidural space minimizes complications, no prospective randomized examination of epidural catheter insertion length has been published. Methods Eight hundred healthy parturients requesting epidural analgesia were randomized to have open-tip epidural catheters inserted 2, 4, 6, or 8 cm within the epidural space. The incidences of intravenous cannulation, unilateral sensory analgesia, and subsequent catheter dislodgment were recorded. Catheter insertions that resulted in intravenous cannulation or unilateral analgesia were incrementally withdrawn and retested with additional local anesthetic to determine the effectiveness of epidural catheter manipulation. Results Epidural catheters inserted 8 cm within the epidural space were more likely to result in intravenous cannulation. Epidural catheters inserted 2 cm within the epidural space were less likely to result in unilateral sensory analgesia but were more likely to become dislodged. Twenty-three percent of epidural catheters inserted > 2 cm within the epidural space required manipulation. Epidural catheters inserted 2 or 4 cm required replacement more often than epidural catheters inserted 6 or 8 cm. Ninety-one percent and 50% of epidural catheters that resulted in unilateral sensory analgesia and intravenous cannulation, respectively, provided analgesia for labor and delivery after incremental withdrawal. Conclusions Epidural catheters should be inserted either 2 cm when rapid labor is anticipated or 6 cm when prolonged labor or cesarean delivery is likely. Additionally, epidural catheters that result in intravenous cannulation or unilateral sensory analgesia can be manipulated effectively to provide analgesia for labor and delivery.

Epidural Analgesia in the Management of Severe Vaso-Occlusive Sickle Cell Crisis

PEDIATRICS ◽  
1994 ◽  
Vol 93 (2) ◽  
pp. 310-315 ◽  
Author(s):  
Myron Yaster ◽  
Joseph R. Tobin ◽  
Carol Billett ◽  
James F. Casella ◽  
George Dover
Keyword(s):  
Epidural Analgesia ◽  
Oxygen Saturation ◽  
Epidural Catheter ◽  
Respiratory Depression ◽  
Sickle Cell ◽  
Local Anesthetic ◽  
Analgesic Therapy ◽  
Plasma Lidocaine ◽  
Continuous Epidural Analgesia ◽  
Epidural Catheters

Objectives. To determine whether continuous epidural analgesia could effectively decrease pain and thereby improve the management of severe vaso-occlusive crisis in children with sickle cell disease who were unresponsive to conventional analgesic therapy. Design. Retrospective observational study. Setting. A tertiary care hospital with a large pediatric sickle cell patient referral population. Patients. The study describes nine children in 11 painful vaso-occlusive crises, unresponsive to high-dose systemic opioids, nonsteroidal anti-inflammatory drugs, and adjunctive measures, who underwent continuous epidural analgesia to control pain. Outcome Measures. Subjective pain scores, arterial oxygen saturation monitoring, and plasma lidocaine levels. Methods. Placement of an epidural catheter for the administration of a continuous infusion of local anesthetic, alone, or in combination with fentanyl, in the management of vaso-occlusive crisis. Results. At initiation of epidural analgesic therapy, 8 of 9 patients reported severe pain (8 to 10 on a scale of 0 to 10, 0 = no pain, 10 = the worst pain they ever experienced). Analgesia was immediate (pain score 0 to 2) in 8 of 9 patients, and continuously effective in 9 of 11 crises. Five patients required either the addition of fentanyl or changing the local anesthetic from lidocaine to bupivacaine to maintain analgesia for 2 to 5 days. In 7 of 9 patients, oxygen saturation dramatically increased from 87 to 95% to 99 to 100% after epidural analgesia was initiated. In all patients, plasma lidocaine levels ranged from 1.1 to 4.6 mg/L and dose-related toxicity did not occur. One patient developed hypotension secondary to high sympathetic blockade (T-4), one had an inadvertent dural puncture during insertion of the catheter, one had the epidural catheter removed for fever, and one achieved analgesia only transiently. There were no other complications, and epidural analgesia was not associated with sedation, respiratory depression, or limitation of movement. All epidural catheters were cultured on removal, and colonization did not occur. Conclusions. Epidural analgesia with local anesthetics administered alone or in combination with fentanyl effectively and safely treats the pain of sickle cell vaso-occlusive crisis unresponsive to conventional pain management and does so without causing sedation, respiratory depression, or significant limitation on ambulation. Furthermore, early treatment of painful crisis with this technique may improve oxygenation, a critical factor in the evolution of further sickling.

Predistention of the Epidural Space Before Catheter Insertion Reduces the Incidence of Intravascular Epidural Catheter Insertion

2008 ◽  
Vol 28 (2) ◽  
pp. 98-99
Author(s):  
S. Evron ◽  
V. Gladkov ◽  
D.I. Sessler ◽  
V. Khazin ◽  
O. Sadan ◽  
...  
Keyword(s):  
Epidural Catheter ◽  
Epidural Space ◽  
Catheter Insertion

Clinical and Bacteriologic Survey of Epidural Analgesia in Patients in the Intensive Care Unit

1996 ◽  
Vol 85 (5) ◽  
pp. 988-998 ◽  
Author(s):  
Bruno Darchy ◽  
Xavier Forceville ◽  
Eric Bavoux ◽  
Frederic Soriot ◽  
Yves Domart
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Epidural Analgesia ◽  
Epidural Catheter ◽  
Strong Predictor ◽  
Insertion Site ◽  
Space Infection ◽  
General Signs ◽  
Epidural Catheters

Background The risk of bacterial contamination related to epidural analgesia in patients cared for in the intensive care unit has not been assessed. Thus the authors studied patients who received care in the intensive care unit who were given epidural analgesia for more than 48 h to determine the rates of local, epidural catheter, and spinal space infection and to identify risk factors. Methods Each patient receiving epidural analgesia for longer than 48 h was examined daily for local and general signs of infection. A swab sample for culture was taken if there was local discharge; all epidural catheters were cultured on withdrawal. All patients underwent weekly neurologic monitoring for 1 month; those with positive epidural catheter cultures had one spinal magnetic resonance image scan. Results The 75 patients cared for in the intensive care unit who were studied had been receiving epidural analgesia for a median of 4 days (interquartile range, 3.5 to 5 days). Twenty-seven patients had signs of local inflammation (erythema or local discharge), and nine of these had infections. All the patients who had both local signs also had infection. All nine infections were local (12%), but four patients also had epidural catheter infections (5.3%). No patient with erythema alone or without local signs had a positive epidural catheter culture. No spinal space infection was diagnosed. Staphylococcus epidermidis was the most frequently cultured microorganism. Local infection was treated by removing the epidural catheter without any antibiotics. Concomitant infection at other sites (21 of 75 patients, or 28%), antibiotic therapy (64 of 75 patients, or 85%), the duration of epidural analgesia, and the insertion site level of the epidural catheter were not identified as risk factors for epidural analgesia-related infections. Conclusions The risk of epidural analgesia-related infection in patients in the intensive care unit seems to be low. The presence of two local signs of inflammation is a strong predictor of local and epidural catheter infection.

Lumbar Sympathetic Blocks Speed Early and Second Stage Induced Labor in Nulliparous Women 

1999 ◽  
Vol 90 (4) ◽  
pp. 1039-1046 ◽  
Author(s):  
Barbara L. Leighton ◽  
Stephen H. Halpern ◽  
Donna B. Wilson
Keyword(s):  
Epidural Analgesia ◽  
Cesarean Delivery ◽  
Delivery Mode ◽  
Sympathetic Block ◽  
Cervical Dilation ◽  
Induced Labor ◽  
Second Stage ◽  
Vaginal Deliveries ◽  
Epidural Catheters ◽  
Sympathetic Blocks

Background Rapid cervical dilation reportedly accompanies lumbar sympathetic blockade, whereas epidural analgesia is associated with slow labor. The authors compared the effects of initial lumbar sympathetic block with those of epidural analgesia on labor speed and delivery mode in this pilot study. Methods At a hospital not practicing active labor management, full-term nulliparous patients whose labors were induced randomly received initial lumbar sympathetic block or epidural analgesia. The latter patients received 10 ml bupivacaine, 0.125%; 50 microg fentanyl; and 100 microg epinephrine epidurally and sham lumbar sympathetic blocks. Patients to have lumbar sympathetic blocks received 10 ml bupivacaine, 0.5%; 25 microg fentanyl; and 50 microg epinephrine bilaterally and epidural catheters. Subsequently, all patients received epidural analgesia. Results Cervical dilation occurred more quickly (57 vs. 120 min/cm cervical dilation; P = 0.05) during the first 2 h of analgesia in patients having lumbar sympathetic blocks (n = 17) than in patients having epidurals (n = 19). The second stage of labor was briefer in patients having lumbar sympathetic blocks than in those having epidurals (105 vs. 270 min; P < 0.05). Nine patients having lumbar sympathetic block and seven having epidurals delivered spontaneously, whereas seven patients having lumbar sympathetic block and seven having epidurals had instrument-assisted vaginal deliveries. Cesarean delivery for fetal bradycardia occurred in one patient having lumbar sympathetic block. Cesarean delivery for dystocia occurred in five patients having epidurals compared with no patient having lumbar sympathetic block (P = not significant). Visual analog pain scores differed only at 60 min after block. Conclusions Nulliparous parturients having induced labor and receiving initial lumbar sympathetic blocks had faster cervical dilation during the first 2 h of analgesia, shorter second-stage labors, and a trend toward a lower dystocia cesarean delivery rate than did patients having epidural analgesia. The effects of lumbar sympathetic block on labor need to be determined in other patient groups. These results may help define the tocodynamic effects of regional labor analgesia.

scholarly journals Using Computed Tomography Scans and Patient Demographic Data to Estimate Thoracic Epidural Space Depth

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Alyssa Kosturakis ◽  
Jose Soliz ◽  
Jackson Su ◽  
Juan P. Cata ◽  
Lei Feng ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Epidural Catheter ◽  
Epidural Space ◽  
Depth Measurement ◽  
Thoracic Epidural ◽  
Patient Demographics ◽  
Loss Of Resistance ◽  
Computed Tomography Scans ◽  
The Mean ◽  
Epidural Catheters

Background and Objectives. Previous studies have used varying methods to estimate the depth of the epidural space prior to placement of an epidural catheter. We aim to use computed tomography scans, patient demographics, and vertebral level to estimate the depth of the loss of resistance for placement of thoracic epidural catheters. Methods. The records of consecutive patients who received a thoracic epidural catheter were reviewed. Patient demographics, epidural placement site, and technique were collected. Preoperative computed tomography scans were reviewed to measure the skin to epidural space distance. Linear regression was used for a multivariate analysis. Results. The records of 218 patients were reviewed. The mean loss of resistance measurement was significantly larger than the mean computed tomography epidural space depth measurement by 0.79 cm (p<0.001). Our final multivariate model, adjusted for demographic and epidural technique, showed a positive correlation between the loss of resistance and the computed tomography epidural space depth measurement (R2=0.5692, p<0.0001). Conclusions. The measured loss of resistance is positively correlated with the computed tomography epidural space depth measurement and patient demographics. For patients undergoing thoracic or abdominal surgery, estimating the loss of resistance can be a valuable tool.

scholarly journals A Rare Presentation of Broken Epidural Catheter

2020 ◽  
Vol 6 (2) ◽  
Keyword(s):  
Epidural Catheter ◽  
Epidural Space ◽  
Successful Management ◽  
Rare Presentation ◽  
Post Operative Period ◽  
Epidural Catheters

We routinely use epidural catheters for intra operative and post operative analgesia. Although there are many known complications of epidural catheters, breakage of the catheter is a rarely encountered but well known complication. We report one such event in post operative period and its successful management. Keywords: Epidural catheter; Epidural space; Documentation; Counselling.

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