title: Lumbar epidural catheter insertion: the midline vs. the paramedian approach.
abstract: OBJECTIVE
  The purpose of this study was to compare the characteristics of epidural catheter insertion via the midline or the paramedian approach with regard to ease of catheter insertion, incidence of paraesthesias and efficacy of epidural block. In addition to the type of approach, the prognostic value of Patients characteristics variables with regard to the incidence of paraesthesias was assessed.
  
  
  METHODS
  Thirty patients scheduled for surgery under epidural anaesthesia were randomly assigned to one of two groups of 15 patients each. Epidural anaesthesia was performed via a midline or paramedian approach using loss of resistance to saline. Variables measured were: time needed to identify the epidural space, time needed for and ease of epidural catheter insertion and the incidence of paraesthesias. After completion of these observations, epidural anaesthesia was established with 150 mg ropivacaine 1%. Efficacy of the epidural block was assessed by the need for intraoperative analgesics and by the patient on a three-point scale (good/fair/poor).
  
  
  RESULTS
  Quality of sensory blockade was adequate in both groups. Catheter insertion was significantly faster using the paramedian approach. The difference between the two approaches with regard to the incidence of paraesthesias was not significant, however, there was a trend towards more paraesthesias in the midline group. In the multivariate analysis, type of approach was an independent significant predictor of paraesthesias and we found a trend towards a higher incidence of paraesthesias in female patients.
  
  
  CONCLUSIONS
  Catheter insertion was faster in the paramedian group and we found a trend towards a higher incidence of paraesthesias with the midline approach.
authors.affiliation: Leiden University Medical Center, Department of Anesthesiology, Leiden, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Leeda
authors.forename: R
authors.initials: R
authors.lastname: Stienstra
authors.forename: M S
authors.initials: MS
authors.lastname: Arbous
authors.forename: A
authors.initials: A
authors.lastname: Dahan
authors.forename: B
authors.initials: B
authors.lastname: Th Veering
authors.forename: A G L
authors.initials: AG
authors.lastname: Burm
authors.forename: J W
authors.initials: JW
authors.lastname: Van Kleef
mesh_terms: D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D010292:Paresthesia / Q000209:etiology / Q000517:prevention & control*