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Insertion length and resistance during advancing of epidural catheter

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Abstract

Purpose

The migration of an epidural catheter into the intravascular and subarachnoid spaces sometimes occurs. This study was designed to investigate where the resistance was felt during the advancing of the catheter into the epidural space and whether the length of catheter advanced in the epidural space affected the incidence of catheter migration.

Methods

One hundred and twenty women, American Society of Anesthesiologists (ASA) 1 or 2, scheduled to undergo lower abdominal surgeries with epidural anesthesia were randomly assigned to two groups according to the length of the epidural catheter advanced; 4 cm (n = 60) or 8 cm (n = 60). The length where resistance to advancing the catheter was perceived was recorded in all patients, and the incidence of aspiration of blood or cerebrospinal fluid (CSF) was obtained. Further, the catheters removed 48 h after surgery were scrutinized for their bending sites.

Results

Resistance was felt in 83 (69.2%) patients and the mean length in the epidural space at which resistance was found was 2.5 ± 1.2 cm. Blood was aspirated in 9 (7.5%) patients when resistance to advancing the catheter was overcome, but CSF was aspirated in no patient. A distal bend was observed 2.4 ± 1.3 cm from the tip of the catheter, and the sites of bending were correlated with the length where resistance was encountered. An additional proximal bend was observed in 35 (58%) patients in the 8-cm group, and in 2 patients (3%) in the 4-cm group (P < 0.001), probably due to coiling of the catheter.

Conclusion

At approximately 2.5 cm in the epidural space, advancing an epidural catheter causes resistance. Further advancing past this point may cause migration of the catheter into the vessels, or the coiling of the catheter.

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References

  1. Savolaine ER, Pandya JB, Greenbalt SH, Conover SR. Anatomy of the human epidural space: new insights using CT-epidurography. Anesthesiology. 1988;68:217–220.

    Article  CAS  PubMed  Google Scholar 

  2. Blomberg GR, Olsson SS. The lumbar epidural space in patients examined with epiduroscopy. Anesth Analg. 1989;68:157–160.

    CAS  PubMed  Google Scholar 

  3. Gallart L, Blanco D, Samso E, Vidal F. Clinical and radiological evidence of the epidural plica mediana dorsalis. Anesth Analg. 1990;71:698–701.

    Article  CAS  PubMed  Google Scholar 

  4. Motamed C, Farhat F, Remerand F, Laplanche A. An analysis of postoperative epidural analgesia failure by computed tomography-epidurography. Anesth Analg. 2006;103:1026–1032.

    Article  CAS  PubMed  Google Scholar 

  5. Usubiaga JE, Dos Reis A, Usubiaga LE, Epidural misplacement of catheters and mechanism of unilateral blockade. Anesthesiology. 1970;32:158–161.

    Article  CAS  PubMed  Google Scholar 

  6. Cesur M, Alici HA, Erdem AF, Silbir F, Yuksek MS. Administration of the local anesthetic through the epidural needle before catheter insertion improves the quality of anesthesia and reduces catheter related complications. Anesth Analg. 2005;101:1501–1505.

    Article  CAS  PubMed  Google Scholar 

  7. D’Angelo R, Berkebile B, Gerancher JC. Prospective examination of epidural catheter insertion. Anesthesiology. 1996;84:1524–1525.

    Article  Google Scholar 

  8. Beilin Y, Bernstein HH, Zucker-Pinchoff B. The optimal distance a multiorifice epidural catheter should be threaded into the epidural space. Anesth Analg. 1995;81:301–304.

    Article  CAS  PubMed  Google Scholar 

  9. Hamilton CL, Riley ET, Cohen SE. Changes in the position of epidural catheters associated with patient movement. Anesthesiology. 1997;86:778–784.

    Article  CAS  PubMed  Google Scholar 

  10. Cartagena R, Gaiser RR. Advancing an epidural catheter 10 cm and then retracting it 5 cm is no more effective than advancing it 5 cm. J Clin Anesth. 2005;17:528–530

    Article  PubMed  Google Scholar 

  11. Lim YJ, Bahk JH, Ahn WS, Lee SC. Coiling of lumbar epidural catheters. Acta Anaesthesiol Scand. 2002;46:603–606.

    Article  CAS  PubMed  Google Scholar 

  12. Sanchez R, Acuna L, Rocha F. An analysis of the radiological visualization of the catheters placed in the epidural space. Br J Anaesth. 1967;39:485–489.

    Article  CAS  PubMed  Google Scholar 

  13. Richardson MG, Wissler RN. The effect of needle bevel orientation during epidural catheter insertion in laboring parturients. Anesth Analg. 1999;88:352–356.

    Article  CAS  PubMed  Google Scholar 

  14. Beck H, Brassow F, Doehn M. Epidural catheters of the multiorifice type: dangers and complications. Acta Anaesthesiol Scand. 1986;30:549–555.

    Article  CAS  PubMed  Google Scholar 

  15. Bridenbaugh LD, Moore DC, Bagdi P, Bridenbaugh PO. The position of plastic tubing in continuous-block techniques. An X-ray study of 552 patients. Anesthesiology. 1967;29:1047–1049.

    Article  Google Scholar 

  16. Quinn Hogan. Epidural catheter tip position and distribution of injectate evaluated by computed tomography. Anesthesiology. 1999;90:964–970.

    Article  Google Scholar 

  17. Kumar CM, Dennison B, Lawier PGP. Excessive dose requirements of local anesthetic for epidural analgesia. How far should an epidural catheter be inserted? Anaesthesia. 1985;40:1100–1102

    Article  CAS  PubMed  Google Scholar 

  18. Asato F, Goto F. Radiographic findings of unilateral epidural block. Anesth Analg. 1996;83:519–522.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (J.I.P.M.E.R), Pondicherry, India

    Pankaj Kundra, Senthil Kumar Viswanath, Dharam S. Meena & Ashok Badhe

  2. DII/21, J.I.P.M.E.R Campus, Pondicherry, 605006, India

    Pankaj Kundra

Authors
  1. Pankaj Kundra
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  2. Senthil Kumar Viswanath
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  3. Dharam S. Meena
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  4. Ashok Badhe
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Kundra, P., Viswanath, S.K., Meena, D.S. et al. Insertion length and resistance during advancing of epidural catheter. J Anesth 23, 494–499 (2009). https://doi.org/10.1007/s00540-009-0818-4

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  • DOI: https://doi.org/10.1007/s00540-009-0818-4

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