A Hazard of Double-orifice Epidural Catheters

Another Misplaced Epidural Catheter

“…Second, the terminal orifice of the catheter tip may have been in the subarachnoid space from the outset, but the proportion of injected dose entering this space was influenced by differences in the speed of injection. This mechanism has been suggested by Ward et al 2 and supported by experiment. These authors concluded that in the event of a catheter terminal orifice being within the subarachnoid space whilst the proximal orifice(s) lie within the epidural space, then the amount of drug ejected from each orifice depends upon the rate and pressure of injection.…”

Epidural catheters of the multi‐orifice type: dangers and complications

“…Therefore, we think that the use of multi-orifice epidural catheters should be eliminated since their advantages have not been drmonstrated, but the vital dangers that can result hacr kwen procen Before deciding on the design of a "sak" epidural catheter, be it with a single opening at the tip or with only one lateral orifice, a further investigation disclosing the ability of these types of catheters to penetrate through the dura, arachnoid mrmbranc and vessel wall must also be conducted. (8,9,12).…”

“…Apart from this, it has been shown ( 1 1, 12) that the volume of local anesthetic flowing through any individual catheter hole is dependent on the injection pressure as well as the patient's position. There have been reports on cases which indicate epidurovasal malpositioning of multi-orifice epidural catheters (10)(11)(12)(13)(14).…”

The intradural space: the fourth place to go astray during epidural block

“…15,16 Such cases were, at the time, attributed to either catheter migration or multicompartment block. Our exact incidence of intradural injection is unknown, as we have only recently started specifically investigating blocks of slow onset, which required additional doses of local anaesthetic, as well as all cases of late subarachnoid block with CSF aspiration.…”