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Bacteriologic Aspects of Epidural Analgesia

FRANCIS M. JAMES, III, MD^*, RICHARD H. GEORGE, MB, ChB, MRCPath, HAMlD NAIEM, MB, BS, MRCOG, and GARY J. WHITE, FIMLT

*Associate Professor of Anesthesia, Department of Anesthesia, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27103. Consultant, Department of Bacteriology, Birmingham Maternity Hospital, Birmingham, England. Research Fellow, Department of Anaesthetics, Birmingham Maternity Hospital. Chief Technician, Department of Bacteriology, Birmingham Maternity Hospital.

Abstract

The incidence of contamination of catheters and syringes used during epidural analgesia for parturients and the effectiveness of bacterial filters were investigated. The effect of bupivacaine on bacterial viability and growth was also studied. Syringes in 5/101 cases were contaminated, while catheter tips located in the epidural space were sterile. Organisms isalated were skin commensals and probably originated on the hands of anesthetic personnel. Bupivacaine (0.25%) was bacteriocidal to S epidermidis and Corynebacteriurn spp at 37 C but not at room temperature. These findings illustrate the efficacy of using bacterial filters during continuous epidural analgesia. New syringes should be used for each epidural injection as insurance against seeding of bacteria in the presence of a defective filter.

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