title: Injecting saline through the epidural needle decreases the iv epidural catheter placement rate during combined spinal-epidural labour analgesia.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Anesthesiology, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021, USA. fgadalla@med.cornell.edu
authors.forename: Farida
authors.initials: F
authors.lastname: Gadalla
authors.forename: Sung-Hee Rhim
authors.initials: SH
authors.lastname: Lee
authors.forename: Kue C
authors.initials: KC
authors.lastname: Choi
authors.forename: Jill
authors.initials: J
authors.lastname: Fong
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Gomillion
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Leighton
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000295:instrumentation*; D016362:Analgesia, Obstetrical / Q000295:instrumentation*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002404:Catheterization; D004824:Epidural Space; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D007268:Injections, Epidural; D007743:Labor, Obstetric / Q000502:physiology*; D011247:Pregnancy; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage / Q000627:therapeutic use*; D017409:Sufentanil / Q000627:therapeutic use
chemical_list: D000701:Analgesics, Opioid; D012965:Sodium Chloride; D017409:Sufentanil; D005283:Fentanyl