Rafael Cartagena1, Robert R Gaiser. 1. Department of Anesthesia, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
Abstract
STUDY OBJECTIVE: To determine whether threading an epidural catheter 10 cm then retracting it 5 cm affects its intravascular placement and paresthesias. DESIGN: Prospective randomized study. SETTING: Labor and Delivery Unit, University Medical Center. PATIENTS: Eighty parturients. INTERVENTIONS: All patients received epidural anesthesia. Patients were randomized to 1 of 2 groups: threading the epidural catheter 5 cm (5-cm group) or threading the epidural catheter 10 cm and retracting 5 cm (10-cm group). In the 10-cm group, the epidural catheter was threaded 10 cm and pulled back 5 cm. In the 5-cm group, the epidural catheter was threaded 5 cm. MEASUREMENTS AND MAIN RESULTS: Placement of the epidural catheter intravascularly, the presence of a paresthesia, and bilateral sensory levels were measured. There was no difference in the frequency of intravascular placement between 10- and 5-cm groups, 10.2% vs 7.5%, respectively. Although not statistically significant, there was a trend toward a higher frequency of paresthesia in the 10-cm group, 15.4% vs 7.5%, and a lower frequency of uneven sensory levels in the 10-cm group, 15% vs 2.6%. CONCLUSIONS: There is no clear clinical benefit or disadvantage to threading an epidural catheter 10 cm into the epidural space then withdrawing it 5 cm. Further study is warranted.
RCT Entities:
STUDY OBJECTIVE: To determine whether threading an epidural catheter 10 cm then retracting it 5 cm affects its intravascular placement and paresthesias. DESIGN: Prospective randomized study. SETTING: Labor and Delivery Unit, University Medical Center. PATIENTS: Eighty parturients. INTERVENTIONS: All patients received epidural anesthesia. Patients were randomized to 1 of 2 groups: threading the epidural catheter 5 cm (5-cm group) or threading the epidural catheter 10 cm and retracting 5 cm (10-cm group). In the 10-cm group, the epidural catheter was threaded 10 cm and pulled back 5 cm. In the 5-cm group, the epidural catheter was threaded 5 cm. MEASUREMENTS AND MAIN RESULTS: Placement of the epidural catheter intravascularly, the presence of a paresthesia, and bilateral sensory levels were measured. There was no difference in the frequency of intravascular placement between 10- and 5-cm groups, 10.2% vs 7.5%, respectively. Although not statistically significant, there was a trend toward a higher frequency of paresthesia in the 10-cm group, 15.4% vs 7.5%, and a lower frequency of uneven sensory levels in the 10-cm group, 15% vs 2.6%. CONCLUSIONS: There is no clear clinical benefit or disadvantage to threading an epidural catheter 10 cm into the epidural space then withdrawing it 5 cm. Further study is warranted.