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OBSTETRIC ANESTHESIOLOGY

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

Shmuel Evron, MD^*, Vladimir Gladkov, MD^*, Daniel I. Sessler, MD, Vadim Khazin, MD^*, Oscar Sadan, MD, Mona Boaz, PhD^¶, and Tiberiu Ezri, MD^*

From the *Department of Anesthesia, Edith Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University, Israel; Outcomes Research Institute and Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky; Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio; Departments of Obstetrics and Gynecology and ¶Epidemiology, Edith Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University, Israel.

Address correspondence and reprint requests to Tiberiu Ezri, MD, Department of Anesthesia, Edith Wolfson Medical Center, Holon 58100, Israel. Address e-mail to tezri{at}netvision.net.il. On the World Wide Web: www.or.org.

Abstract

BACKGROUND: Accidental cannulation of an epidural vein is a common complication associated with epidural anesthesia or analgesia. On the basis of a pilot study and previous reports, we tested the hypothesis that predistention of the epidural space with saline before epidural catheterization would ease catheter insertion and decrease the incidence of this complication.

METHODS: Two-hundred-three laboring women were randomly assigned to receive an epidural with loss of resistance technique with 2 mL (nondistention) or 5 mL saline (distention). In the distention group, the syringe plunger was held closed before epidural catheter insertion. Then in both groups, a test dose of 3 mL of 1.5% lidocaine was injected through the epidural catheter.

RESULTS: There were fewer accidental intravascular catheter placements (2% vs 16%, P = 0.0001) in the distention group, and 91% of patients in this group did not have any unblocked segments versus 67% in the nondistension group (P = 0.0001). The difference in onset time of analgesia was small (5.0 ± 2 min vs 6 ± 3 min, P = 0.0001) and not clinically important. The quality of analgesia (visual analog scores and ropivacaine consumption) was similar between groups.

CONCLUSIONS: Distention of the epidural space with 5 mL saline before epidural catheter insertion decreased the incidence of accidental venous cannulation and the number of unblocked segments.

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