title: The lateral recumbent head-down position decreases the incidence of epidural venous puncture during catheter insertion in obese parturients.
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 in three different body positions, in a cohort of morbidly obese parturients, following the completion of a similar study published in 2001 from which such parturients were excluded.
  
  
  METHODS
  The study was conducted in 450 (three groups of 150) morbidly obese, obstetric patients undergoing continuous epidural analgesia during labour. Epidural catheterization was performed on patients randomized to 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 [1.3%; body mass index (BMI): 37.0] than in the lateral recumbent horizontal [12.9%; BMI: 38.0] and in the sitting position [12.0%; BMI: 38.0]. The incidence of accidental subarachnoid puncture was 2%, 1.3% and 2% respectively, in these same positions.
  
  
  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 in these obese parturients.
authors.affiliation: Department of Anesthesiology, Assaf Harofeh Medical Center, Zerifin, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. anesthesia@asaf.health.gov.il
authors.forename: Murat
authors.initials: M
authors.lastname: Bahar
authors.forename: Michael
authors.initials: M
authors.lastname: Chanimov
authors.forename: Mathias L
authors.initials: ML
authors.lastname: Cohen
authors.forename: Mark
authors.initials: M
authors.lastname: Friedland
authors.forename: Ina
authors.initials: I
authors.lastname: Shul
authors.forename: Vladislav
authors.initials: V
authors.lastname: Gofman
authors.forename: Shlomo
authors.initials: S
authors.lastname: Gershfeld
authors.forename: Rima
authors.initials: R
authors.lastname: Geller
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Sherman
mesh_terms: D000059:Accidents; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000009:adverse effects / Q000379:methods*; D015992:Body Mass Index; D015331:Cohort Studies; D004388:Dura Mater / Q000098:blood supply / Q000293:injuries; D004824:Epidural Space; D005260:Female; D018475:Head-Down Tilt / Q000502:physiology*; D006801:Humans; D009767:Obesity, Morbid / Q000150:complications*; D011187:Posture / Q000502:physiology; D011247:Pregnancy; D011248:Pregnancy Complications; D013129:Spinal Puncture / Q000009:adverse effects; D014680:Veins / Q000293:injuries