Accidental venous and dural puncture during epidural analgesia in obese parturients (BMI > 40 kg/m2): three different body positions during insertion.
OBJECTIVE
To assess the frequency of blood vessel punctures in morbidly obese parturients [body mass index (BMI) > 40 kg/m(2)] during epidural catheterization, in three different body positions.


METHODS
Prospective, randomized study.


METHODS
Delivery room of a university-affiliated hospital.


METHODS
347 obese parturients (BMI > 40 kg/m(2)) undergoing continuous epidural analgesia during labor.


METHODS
Patients were randomized to undergo epidural catheterization in the sitting, lateral recumbent horizontal, or lateral recumbent head-down positions.


RESULTS
A lower frequency of epidural venous cannulation was noted when this procedure was performed in the lateral recumbent head-down position (4.8%) than in the lateral recumbent horizontal (11.6%) or sitting position (18.3%) (P = 0.001). Frequency of accidental subarachnoid puncture did not differ significantly (2.5%, 2.6%, and 3.7%), respectively.


CONCLUSIONS
Adoption of the lateral recumbent head-down position for the performance of lumbar epidural blockade in labor at term reduces the frequency of lumbar epidural venous puncture in obese parturients (BMI > 40 kg/m(2)).
Department of Anesthesiology, Assaf Harofeh Medical Center, Zerifin 70300, Israel.
Michael
M
Chanimov
Shmuel
S
Evron
Zoya
Z
Haitov
Sorin
S
Stolero
Mathias L
ML
Cohen
Mark
M
Friedland
Ina
I
Shul
Murat
M
Bahar
D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects* / Q000379:methods; D016362:Analgesia, Obstetrical / Q000009:adverse effects* / Q000379:methods; D005260:Female; D018475:Head-Down Tilt; D006801:Humans; D009767:Obesity, Morbid / Q000150:complications*; D011187:Posture; D011247:Pregnancy; D011446:Prospective Studies; D013129:Spinal Puncture; D014680:Veins / Q000293:injuries