Abstract
Purpose
To determine if injecting 10 mL saline before epidural catheter threading (pre-cannulation epidural fluid injection) can decrease the incidence ofiv epidural catheter placement during combined spinal-epidural (CSE) labour analgesia.
Methods
One hundred healthy women requesting CSE labour analgesia with either fentanyl 20 μg or sufentanil 10 μg were prospectively randomized to receive either no epidural injection (dry group,n = 50) or epidural 10 mL saline injection (saline group,n = 50) before epidural catheter placement. A nylon multiport catheter was then threaded 3–5 cm into the epidural space and the needle was removed. We diagnosediv catheter placement if blood was freely aspirated, if the mother became tachycardic after injection of epinephrine 15 μg, or if intracardiac air was heard (using ultrasound) after injection of air 1.5 mL.
Results
Intravenous epidural catheter placement occurred in one saline and ten dry group patients (P < 0.01). No complications of excessive cephalad intrathecal opioid spread (i.e., difficulty swallowing, hypoxemia, or respiratory arrest) occurred.
Conclusions
Injecting 10 mL or saline through the epidural needle after intrathecal opioid injection and before threading the catheter significantly decreased accidental venous catheter placement without any apparent increase in complications from excessive cephalad intrathecal opioid spread.
Résumé
Objectif
Vérifier si l’injection de 10 mL de solution saline avant d’enfiler le cathéter péridural (injection de liquide pré-insertion) peut réduire l’incidence de canulation iv du cathéter péridural pendant l’analgésie rachidienne péridurale combinée (RPC) pour le travail.
Méthode
Cent femmes en bonne santé voulant une analgésie RPC, soit avec 20 μg de fentanyl, soit 10 μg de sufentanil, ont été réparties prospectivement au hasard. Il n’y a pas eu d’injection péridurale dans le groupe témoin (n = 50) mais l’injection péridurale de 10 mL de solution saline dans le groupe salin (n = 50) avant la mise en place du cathéter péridural. Un cathéter de nylon à ouvertures multiples a été ensuite poussé de 3–5 cm à l’intérieur de l’espace péridural et l’aiguille a été retirée. Laspiration libre de sang, la tachycardie de la mère suivant l’injection de 15 μg d’épinéphrine ou la présence d’air intracardiaque, décelée par ultrasons après l’injection de 1,5 mL d’air, indiquaient la canulation iv du cathéter.
Résultats
La canulation intraveineuse du cathéter péridurai est survenue chez une patiente du groupe salin et dix patientes témoins (P < 0,01). Aucune complication causée par la diffusion marquée de l’opioïde intrathécal en direction céphalique (comme la déglutition difficile, l’hypoxémie ou l’arrêt respiratoire) n’a été notée.
Conclusion
L’injection, par l’aiguille péridurale, de 10 mL de solution saline après l’injection intrathécale d’opioïde et avant l’insertion du cathéter a fait diminuer significativement la canulation place veineuse accidentelle du cathéter, sans augmentation apparente de complications causées par la diffusion marquée d’opioïde intrathécal en direction céphalique.
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This research was supported solely by departmental funds.
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Gadalla, F., Lee, SH.R., Choi, K.C. et al. Injecting saline through the epidural needle decreases theiv epidural catheter placement rate during combined spinal-epidural labour analgesia. Can J Anesth 50, 382–385 (2003). https://doi.org/10.1007/BF03021036
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DOI: https://doi.org/10.1007/BF03021036