title: Prior epidural injection of 10 ml normal saline reduces the incidence of inadvertant venous puncture in epidural catheterization.
abstract: BACKGROUND
  Anesthetically, epidural neural blockade is widely used in the fields of surgery and obstetrics as well as in diagnosis and management of acute and chronic pain. However, inadvertent epidural venous puncture might be a serious problem, or even life-threatening particularly when drug is erronaneously injected and prompt diagnosis is not made correct and treatment is not instituted. Although many anesthesiologists suggested that injection of fluid into the epidural space before catheter insertion could prevent an epidural venous puncture, some others did not agree to it. This study aimed a assess the effect of injection of different volumes of saline into the epidural space before catheter insertion on the incidence of epidural venous puncture.
  
  
  METHODS
  Three hundred ASA I or II patients receiving Extracorporeal Shock Wave Lithotripsy (ESWL) were randomly divided into three groups: group A (no saline), group B (5 ml of saline) and group C (10 ml of saline). After the injection of different volume of saline into the epidural space, an epidural catheter was inserted into the epidural space via a Touhy needle. The incidence of epidural venous puncture in each group was compared.
  
  
  RESULTS
  The incidence of epidural venous puncture in group A and B was 14% and 11%, respectively. However, the incidence in group C (1%) was significantly lower than the other two groups.
  
  
  CONCLUSIONS
  Our results suggest that injection of 10 ml saline into the epidural space before catheter insertion could significantly diminish the incidence of epidural venous puncture.
authors.affiliation: Department of Anesthesiology, Chang-Gung Memorial Hospital, Lin-Kou, Taiwan, R.O.C.
authors.forename: C H
authors.initials: CH
authors.lastname: Tseng
authors.forename: A H
authors.initials: AH
authors.lastname: Li
authors.forename: H
authors.initials: H
authors.lastname: Kuo-Sheng
authors.forename: R S
authors.initials: RS
authors.lastname: Wu
authors.forename: P P
authors.initials: PP
authors.lastname: Tan
mesh_terms: D000328:Adult; D000368:Aged; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D002404:Catheterization / Q000009:adverse effects*; D006801:Humans; D007268:Injections, Epidural; D008096:Lithotripsy; D008875:Middle Aged; D012965:Sodium Chloride; D014680:Veins / Q000293:injuries*; D014950:Wounds, Penetrating / Q000517:prevention & control*
chemical_list: D012965:Sodium Chloride