title: Advancing an epidural catheter 10 cm then retracting it 5 cm is no more effective than advancing it 5 cm.
abstract: OBJECTIVE
  To determine whether threading an epidural catheter 10 cm then retracting it 5 cm affects its intravascular placement and paresthesias.
  
  
  METHODS
  Prospective randomized study.
  
  
  METHODS
  Labor and Delivery Unit, University Medical Center.
  
  
  METHODS
  Eighty parturients.
  
  
  METHODS
  All patients received epidural anesthesia. Patients were randomized to 1 of 2 groups: threading the epidural catheter 5 cm (5-cm group) or threading the epidural catheter 10 cm and retracting 5 cm (10-cm group). In the 10-cm group, the epidural catheter was threaded 10 cm and pulled back 5 cm. In the 5-cm group, the epidural catheter was threaded 5 cm.
  
  
  RESULTS
  Placement of the epidural catheter intravascularly, the presence of a paresthesia, and bilateral sensory levels were measured. There was no difference in the frequency of intravascular placement between 10- and 5-cm groups, 10.2% vs 7.5%, respectively. Although not statistically significant, there was a trend toward a higher frequency of paresthesia in the 10-cm group, 15.4% vs 7.5%, and a lower frequency of uneven sensory levels in the 10-cm group, 15% vs 2.6%.
  
  
  CONCLUSIONS
  There is no clear clinical benefit or disadvantage to threading an epidural catheter 10 cm into the epidural space then withdrawing it 5 cm. Further study is warranted.
authors.affiliation: Department of Anesthesia, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Cartagena
authors.forename: Robert R
authors.initials: RR
authors.lastname: Gaiser
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000379:methods*; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D010292:Paresthesia / Q000209:etiology; D010865:Pilot Projects; D011247:Pregnancy; D011446:Prospective Studies