H Bomberg1, N Paquet2, A Huth2, S Wagenpfeil3, P Kessler4, H Wulf5, T Wiesmann5, T Standl6, A Gottschalk7, J Döffert8, W Hering9, J Birnbaum10, B Kutter11, J Winckelmann11, S Liebl-Biereige12, W Meissner13, O Vicent14, T Koch14, H Bürkle15, D I Sessler16, A Raddatz2, T Volk2. 1. Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Medical Centre, Saarland University, Kirrbergerstraße 1, 66421, Homburg/Saar, Germany. Hagen.Bomberg@uks.eu. 2. Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Medical Centre, Saarland University, Kirrbergerstraße 1, 66421, Homburg/Saar, Germany. 3. Institute for Medical Biometry, Epidemiology and Medical Informatics, University Medical Centre, Saarland University, Homburg/Saar, Germany. 4. Department of Anaesthesiology, Intensive Care and Pain Medicine, Orthopaedic University Hospital, Frankfurt, Germany. 5. Department of Anaesthesiology and Intensive Care Therapy, Philipps University Marburg, Marburg, Germany. 6. Department of Anaesthesia, Intensive and Palliative Care Medicine, Academic Hospital Solingen, Solingen, Germany. 7. Department of Anaesthesiology, Intensive Care- and Pain Medicine, Friederikenstift Hannover, Hannover, Germany. 8. Department of Anaesthesiology and Intensive Care Medicine, Hospital Calw-Nagold, Calw-Nagold, Germany. 9. Department of Anaesthesiology, St. Marien-Hospital, Siegen, Germany. 10. Department of Anaesthesiology and Operative Intensive Care Medicine, Charité Campus Virchow Klinikum and Campus Mitte, Charité University Medicine Berlin, Berlin, Germany. 11. Department of Anaesthesiology, Intensive Care and Pain Therapy, University and Rehabilitation Clinics, Ulm, Germany. 12. Department of Anaesthesiology, Intensive Care and Pain Therapy, HELIOS Hospital Erfurt, Erfurt, Germany. 13. Department of Anaesthesiology and Intensive Care, Jena University Hospital, Jena, Germany. 14. Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany. 15. Department of Anaesthesiology and Critical Care, Medical Center, Medical Faculty University Freiburg, University of Freiburg, Freiburg, Germany. 16. Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.
Abstract
BACKGROUND: Dural puncture, paraesthesia and vascular puncture are the most common complications of epidural catheter insertion. Their association with variation in midline needle insertion depth is unknown. OBJECTIVE: This study evaluated the risk of dural and vascular punctures and the unwanted events paraesthesia and multiple skin punctures related to midline needle insertion depth. MATERIAL AND METHODS: A total of 14,503 epidural catheter insertions including lumbar (L1-L5; n = 5367), low thoracic (T7-T12, n = 8234) and upper thoracic (T1-T6, n = 902) insertions, were extracted from the German Network for Regional Anaesthesia registry between 2007 and 2015. The primary outcomes were compared with logistic regression and adjusted (adj) for confounders to determine the risk of complications/events. Results are presented as odds ratios (OR, [95% confidence interval]). MAIN RESULTS: Midline insertion depth depended on body mass index, sex, and spinal level. After adjusting for confounders increased puncture depth (cm) remained an independent risk factor for vascular puncture (adjOR 1.27 [1.09-1.47], p = 0.002) and multiple skin punctures (adjOR 1.25 [1.21-1.29], p < 0.001). In contrast, dural punctures occurred at significantly shallower depths (adjOR 0.73 [0.60-0.89], p = 0.002). Paraesthesia was unrelated to insertion depth. Body mass index and sex had no influence on paraesthesia, dural and vascular punctures. Thoracic epidural insertion was associated with a lower risk of vascular puncture than at lumbar sites (adjOR 0.39 [0.18-0.84], p = 0.02). CONCLUSION: Variation in midline insertion depth is an independent risk factor for epidural complications; however, variability precludes use of depth as a reliable guide to insertion in individual patients.
BACKGROUND: Dural puncture, paraesthesia and vascular puncture are the most common complications of epidural catheter insertion. Their association with variation in midline needle insertion depth is unknown. OBJECTIVE: This study evaluated the risk of dural and vascular punctures and the unwanted events paraesthesia and multiple skin punctures related to midline needle insertion depth. MATERIAL AND METHODS: A total of 14,503 epidural catheter insertions including lumbar (L1-L5; n = 5367), low thoracic (T7-T12, n = 8234) and upper thoracic (T1-T6, n = 902) insertions, were extracted from the German Network for Regional Anaesthesia registry between 2007 and 2015. The primary outcomes were compared with logistic regression and adjusted (adj) for confounders to determine the risk of complications/events. Results are presented as odds ratios (OR, [95% confidence interval]). MAIN RESULTS: Midline insertion depth depended on body mass index, sex, and spinal level. After adjusting for confounders increased puncture depth (cm) remained an independent risk factor for vascular puncture (adjOR 1.27 [1.09-1.47], p = 0.002) and multiple skin punctures (adjOR 1.25 [1.21-1.29], p < 0.001). In contrast, dural punctures occurred at significantly shallower depths (adjOR 0.73 [0.60-0.89], p = 0.002). Paraesthesia was unrelated to insertion depth. Body mass index and sex had no influence on paraesthesia, dural and vascular punctures. Thoracic epidural insertion was associated with a lower risk of vascular puncture than at lumbar sites (adjOR 0.39 [0.18-0.84], p = 0.02). CONCLUSION: Variation in midline insertion depth is an independent risk factor for epidural complications; however, variability precludes use of depth as a reliable guide to insertion in individual patients.
Authors: E A C Bouman; H F Gramke; N Wetzel; T H T Vanderbroeck; R Bruinsma; M Theunissen; H E M Kerkkamp; M A E Marcus Journal: Acta Anaesthesiol Belg Date: 2007
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