Effects of Epinephrine in the Epidural Space on the Incidence of Blood Vessel Injury by Epidural Catheter Insertion for Cesarean Section

AbstractObjective:The objective of this study was to determine if injecting 10 ml saline in epidural space before epidural catheter placement in pregnant women undergoing cesarean section can decrease the frequency of inadvertent intravascular catheter placement.Study Design:Randomize Controlled Trail.Place and Duration of Study:Department of Anaesthesia at Gynaecology and Obstetrics operation theater, Jinnah Hospital, Lahore affiliated with College of Physician and Surgeon Pakistan from April 2008 to March 2009.Methodology:Sixty pregnant patients (ASA I and II) randomly allocated in Group A and B equally for elec-tive cesarean section were selected. In each patient epidural space was identified with LOR technique using air in sitting position. In Group A (dry group), no saline was injected while in Group B (saline gro-up), 10 ml saline was injected before epidural catheter placement. Using 16 G Toughy needle, catheter was inserted up to 4 cm in the epidural space. To find out inadvertent intravascular catheter placement, epidural catheter was aspirated to exclude blood. After negative aspiration, test dose of 3ml injection xylocain 2% (with adrenaline 1:200,000) was administrated and patient were monitored one minute for increase in heart rate (> 20% of baseline), tinnitus and perioral numbness.Results:In both group data collected was analyzed in SPSS version 11 and Chi-square test was applied. P value of 0.05 or less was taken significant. Percentage of positive inadvertent intravascular catheterization in term of bloody aspirate (20 and 13.3%) was not signi-ficantly different between two groups (P value = 0.488). Increase in heart rate, tinnitus and perioral numbness was not observed in any patient.Conclusion:There was no significant difference in accidental intravascular catheterization if 10 ml saline is injected through needle before catheter insertion.Key word:Epidural catheter, accidental intravascular catheterization, anaesthesia.

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Prediction of the distance from skin to epidural space for low-thoracic epidural catheter insertion by computed tomography

British Journal of Anaesthesia ◽

10.1093/bja/aeh053 ◽

2004 ◽

Vol 92 (2) ◽

pp. 271-273 ◽

Cited By ~ 20

Author(s):

M.C. Kao ◽

S.K. Tsai ◽

W.K. Chang ◽

H.T. Liu ◽

Y.C. Hsieh ◽

...

Keyword(s):

Computed Tomography ◽

Epidural Catheter ◽

Epidural Space ◽

Catheter Insertion ◽

Thoracic Epidural ◽

Thoracic Epidural Catheter

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

Survey of Anesthesiology ◽

10.1097/01.sa.0000307876.14425.96 ◽

2008 ◽

Vol 52 (3) ◽

pp. 120

Author(s):

&NA;

Keyword(s):

Epidural Catheter ◽

Epidural Space ◽

Catheter Insertion

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Prospective Examination of Epidural Catheter Insertion

Anesthesiology ◽

10.1097/00000542-199601000-00011 ◽

1996 ◽

Vol 84 (1) ◽

pp. 88-93 ◽

Cited By ~ 61

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.

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