Complications can occur during epidural placement for women in labor. As many as 23% of epidural anesthetics may not provide satisfactory analgesia. The cause of this may be technical. This study was undertaken to determine the optimal distance that a multiorifice catheter should be threaded into the epidural space to maximize analgesia and minimize complications. One hundred women in labor were enrolled in this prospective, randomized, and double-blind study. Patients were randomly assigned to have the epidural catheter threaded 3, 5, or 7 cm into the epidural space. After placement of the catheter and administration of a test dose with 3 mL of 0.25% bupivacaine, an additional 10 mL of 0.25% bupivacaine was administered in two divided doses. Fifteen minutes later, the adequacy of the analgesia was assessed by a blinded observer. We found that catheter insertion to a depth of 7 cm was associated with the highest rate of insertion complications while insertion to a depth of 5 cm was associated with the highest incidence of satisfactory analgesia. For women in labor who require continuous lumbar epidural anesthesia, we recommend threading a multiorifice epidural catheter 5 cm into the epidural space.
Pruritus is a common and bothersome side effect of neuraxial opioids after cesarean section. Subhypnotic doses of I.V. propofol (10 mg) have been used to treat pruritus caused by neuraxial opioids. In this prospective, randomized, double-blind study, we found that propofol does not relieve pruritus in women who underwent cesarean section and received intrathecal morphine sulfate (0.25 mg) for postoperative pain relief.
Administration of additional local anesthetic without first withdrawing the epidural catheter will effectively treat most women for whom analgesia is incomplete after the placement of an epidural catheter during labor.
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