title: The optimal distance that a multiorifice epidural catheter should be threaded into the epidural space.
abstract: Complications can occur during epidural placement for women in labor. As many as 23% of epidural anesthetics may not provide satisfactory analgesia. The cause of this may be technical. This study was undertaken to determine the optimal distance that a multiorifice catheter should be threaded into the epidural space to maximize analgesia and minimize complications. One hundred women in labor were enrolled in this prospective, randomized, and double-blind study. Patients were randomly assigned to have the epidural catheter threaded 3, 5, or 7 cm into the epidural space. After placement of the catheter and administration of a test dose with 3 mL of 0.25% bupivacaine, an additional 10 mL of 0.25% bupivacaine was administered in two divided doses. Fifteen minutes later, the adequacy of the analgesia was assessed by a blinded observer. We found that catheter insertion to a depth of 7 cm was associated with the highest rate of insertion complications while insertion to a depth of 5 cm was associated with the highest incidence of satisfactory analgesia. For women in labor who require continuous lumbar epidural anesthesia, we recommend threading a multiorifice epidural catheter 5 cm into the epidural space.
authors.affiliation: Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Beilin
authors.forename: H H
authors.initials: HH
authors.lastname: Bernstein
authors.forename: B
authors.initials: B
authors.lastname: Zucker-Pinchoff
mesh_terms: D015360:Analgesia, Epidural / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D016362:Analgesia, Obstetrical / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D002045:Bupivacaine / Q000008:administration & dosage; D002404:Catheterization / Q000295:instrumentation; D004311:Double-Blind Method; D004824:Epidural Space; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D009407:Nerve Block; D010147:Pain Measurement; D010292:Paresthesia / Q000209:etiology; D011247:Pregnancy; D011446:Prospective Studies; D013346:Subarachnoid Space; D013499:Surface Properties; D014680:Veins
chemical_list: D002045:Bupivacaine