High quality labour analgesia using small gauge epidural needles and catheters.
OBJECTIVE
Inadvertent epidural needle punctures represent the leading cause of severe postdural puncture headache (PDPH) in parturients. Use of small gauge (G) epidural needles for continuous analgesia has received little attention despite possible important reductions in PDPH. We report the first study to examine the feasibility of using small G Tuohy needles and 23 G catheters for labour analgesia.


METHODS
Healthy parturients <or= 6 cm dilated were recruited. Epidural analgesia was established using a 19 G Tuohy epidural needle, a 23 G single port 40 cm catheter and bupivacaine 0.08% with fentanyl 2 microg x mL(-1) (15-20 mL). Breakthrough pain was treated by protocol. There was no formal in-training period for anesthesiologists. The primary outcome was the combined failure rate for initiation (failed needle/catheter placement or failed block <or= 30 min of drug administration). Secondary out-comes included late block failure (> 30 min), recognized dural puncture, PDPH, patient assessment of analgesia within 24 hr of delivery, complications and anesthesiologist satisfaction.


RESULTS
Twenty-seven parturients were recruited. Successful blocks were initiated and maintained in 24/27 who rated overall analgesia from good to excellent (19/24 very good to excellent). Three block failures occurred at the initiation phase only (two unilateral, one absent). There was no evidence of catheter kinking after placement. One patient developed PDPH after unrecognized dural puncture which was self-treated with acetaminophen for four days, followed by complete symptom resolution.


CONCLUSIONS
It is feasible to provide high quality labour analgesia using small G epidural needles and catheters. The effect of small G epidural needles on PDPH warrants future study.
Angle
Pamela J
PJ
Department of Anesthesia, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Ontario M5S 1B2, Canada. pamela.angle@sw.ca
Hussain
Kamal
K
Morgan
Anwar
A
Halpern
Stephen H
SH
Van der Vyver
Martin
M
Yee
Jennifer
J
Kiss
Alexander
A
D000328:Adult; D015360:Analgesia, Epidural / Q000295:instrumentation*; D016362:Analgesia, Obstetrical / Q000295:instrumentation*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D002404:Catheterization / Q000295:instrumentation*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007743:Labor, Obstetric / Q000187:drug effects / Q000502:physiology*; D009339:Needles; D051299:Post-Dural Puncture Headache / Q000517:prevention & control; D011247:Pregnancy; D012016:Reference Values; D016896:Treatment Outcome
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine