title: Superiority of multi-orifice over single-orifice epidural catheters for labor analgesia and cesarean delivery.
abstract: OBJECTIVE
  To investigate whether a change from a single-orifice to multi-orifice catheter could reduce the incidence of inadequate epidural blocks requiring replacement of the epidural catheter in obstetric patients.
  
  
  METHODS
  Prospective before-after cohort study.
  
  
  METHODS
  Obstetric unit at a university hospital.
  
  
  METHODS
  872 patients requesting epidural analgesia for vaginal delivery or cesarean section.
  
  
  METHODS
  Patients received epidural analgesia via single-orifice (n = 433) or multi-orifice (n = 439) epidural catheters, depending on the month of the trial.
  
  
  RESULTS
  Patient characteristics, obstetric procedure, anesthesiologist characteristics, and details of epidural placement did not differ significantly between the groups. The overall replacement rate was 14.3% in the single-orifice group versus 9.3% in the multi-orifice group (p = 0.032). There were no difference in the frequency of replacement for subarachnoid placement or migration, immediate intravascular placement, vascular migration, or absence of any block. Significantly fewer catheters were replaced in the multi-orifice group for inadequate analgesia, defined as unblocked segments or unilateral block (6.4% vs. 2.8%, p = 0.018). Paresthesias were less common in the multi-orifice group (22.4% vs. 31.5%, p = 0.003). There were no unrecognized subarachnoid or vascular catheter placements in either group.
  
  
  CONCLUSIONS
  The multi-orifice design offers significant advantages over the single-orifice type for obstetricepidural analgesia.
authors.affiliation: Department of Anaesthesia, Harvard Medical School, Boston, MA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Segal
authors.forename: S
authors.initials: S
authors.lastname: Eappen
authors.forename: S
authors.initials: S
authors.lastname: Datta
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000295:instrumentation*; D016362:Analgesia, Obstetrical / Q000009:adverse effects / Q000295:instrumentation*; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation; D002585:Cesarean Section; D005260:Female; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies