title: Lateral recumbent head-down posture for epidural catheter insertion reduces intravascular injection.
abstract: OBJECTIVE
  The unintentional and unrecognized cannulation of an extradural vein is a potentially serious complication of an epidural anesthetic. The present study was undertaken to assess the incidence of blood vessel puncture related to epidural catheterization performed in three different body positions.
  
  
  METHODS
  The study was conducted in 900 (three groups of 300) obstetric patients undergoing continuous epidural analgesia during their labour and who were randomly allocated to three groups. Epidural catheterization was performed with patients in the sitting, lateral recumbent horizontal, or lateral recumbent head-down position.
  
  
  RESULTS
  There was a lower incidence of vessel cannulation when this procedure was performed in the lateral recumbent head-down position (2%) than in the lateral recumbent horizontal (6%) and in the sitting position (10.7%).
  
  
  CONCLUSIONS
  Adoption of the lateral recumbent head-down position for the performance of lumbar epidural blockade, in labour at term, reduces the incidence of lumbar epidural venous puncture.
authors.affiliation: Department of Anesthesiology, Assaf Harofeh Medical Center, Zerifin, Israel. anesthesia@asaf.health.gov.il
authors.forename: M
authors.initials: M
authors.lastname: Bahar
authors.forename: M
authors.initials: M
authors.lastname: Chanimov
authors.forename: M L
authors.initials: ML
authors.lastname: Cohen
authors.forename: M
authors.initials: M
authors.lastname: Friedland
authors.forename: Y
authors.initials: Y
authors.lastname: Grinshpon
authors.forename: R
authors.initials: R
authors.lastname: Brenner
authors.forename: I
authors.initials: I
authors.lastname: Shul
authors.forename: R
authors.initials: R
authors.lastname: Datsky
authors.forename: D J
authors.initials: DJ
authors.lastname: Sherman
mesh_terms: D000293:Adolescent; D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004824:Epidural Space; D005260:Female; D018475:Head-Down Tilt / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D013129:Spinal Puncture; D013346:Subarachnoid Space / Q000293:injuries