Lateral recumbent head-down posture for epidural catheter insertion reduces intravascular injection

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 performed in three different body positions. The...

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Bibliographic Details
Published in:Canadian journal of anesthesia 2001, Vol.48 (1), p.48-53
Main Authors: BAHAR, Murat, CHANIMOV, Michael, COHEN, Mathias L, FRIEDLAND, Mark, GRINSHPON, Yelena, BRENNER, Rina, SHUL, Ina, DATSKY, Roman, SHERMAN, Dan J
Format: Article
Language:English
Subjects:
Adolescent
Adult
Analgesia, Epidural - adverse effects
Analgesia, Epidural - instrumentation
Analgesia, Epidural - methods
Analgesia, Obstetrical - adverse effects
Analgesia, Obstetrical - instrumentation
Analgesia, Obstetrical - methods
Anesthesia
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Catheters
Epidural Space
Female
Head-Down Tilt - physiology
Humans
Intubation
Local anesthesia. Pain (treatment)
Medical sciences
Middle Aged
Nursing
Pregnancy
Spinal Puncture
Subarachnoid Space - injuries
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Summary: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 performed in three different body positions. The study was conducted in 900 (three groups of 300) obstetric patients undergoing continuous epidural analgesia during their labour and who were randomly allocated to three groups. Epidural catheterization was performed with patients in the sitting, lateral recumbent horizontal, or lateral recumbent head-down position. There was a lower incidence of vessel cannulation when this procedure was performed in the lateral recumbent head-down position (2%) than in the lateral recumbent horizontal (6%) and in the sitting position (10.7%). 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.
ISSN:0832-610X
1496-8975
DOI:10.1007/bf03019814