Department of Anesthesiology

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Injecting saline through the epidural needle decreases the iv epidural catheter placement rate during combined spinal-epidural labour analgesia.

TitleInjecting saline through the epidural needle decreases the iv epidural catheter placement rate during combined spinal-epidural labour analgesia.
Publication TypeJournal Article
Year of Publication2003
AuthorsGadalla F, Lee S-HRhim, Choi KC, Fong J, Gomillion MC, Leighton BL
JournalCan J Anaesth
Volume50
Issue4
Pagination382-5
Date Published2003 Apr
ISSN0832-610X
KeywordsAdult, Analgesia, Epidural, Analgesia, Obstetrical, Analgesics, Opioid, Catheterization, Epidural Space, Female, Fentanyl, Humans, Injections, Epidural, Labor, Obstetric, Pregnancy, Prospective Studies, Sodium Chloride, Sufentanil
Abstract

PURPOSE: To determine if injecting 10 mL saline before epidural catheter threading (pre-cannulation epidural fluid injection) can decrease the incidence of iv epidural catheter placement during combined spinal-epidural (CSE) labour analgesia.

METHODS: One hundred healthy women requesting CSE labour analgesia with either fentanyl 20 microg or sufentanil 10 microg 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 diagnosed iv catheter placement if blood was freely aspirated, if the mother became tachycardic after injection of epinephrine 15 microg, 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.

DOI10.1007/BF03021036
Alternate JournalCan J Anaesth
PubMed ID12670816