Administration of Local Anesthetic Through the Epidural Needle Before Catheter Insertion Improves the Quality of Anesthesia and Reduces Catheter-Related Complications

Abstract

Epidural catheter placement offers flexibility in block management. However, during epidural catheter insertion, complications such as paresthesia and venous and subarachnoid cannulation may occur, and suboptimal catheter placement can affect the quality of anesthesia. We performed this prospective, randomized, double-blind study to assess the effect of a single-injection dose of local anesthetic (20 mL of 2% lidocaine) through the epidural needle as a priming solution into the epidural space before catheter insertion. We randomized 240 patients into 2 equal groups and measured the quality of anesthesia and the incidence of complications. In the needle group (n = 100), catheters were inserted after injection of a full dose of local anesthetic through the needle. In the catheter group (n = 98), the catheters were inserted immediately after identification of the epidural space. Local anesthetic was then injected via the catheter. We noted the occurrence of paresthesia, inability to advance the catheter, or IV or subarachnoid catheter placement. Sensory and motor block were assessed 20 min after the injection of local anesthetic. Surgery was initiated when adequate sensory loss was confirmed. In the catheter group, the incidence of paresthesia during catheter placement was 31.6% compared with 11% in the needle group (P = 0.00038). IV catheterization occurred in 8.2% versus 2% of patients in the catheter and needle groups, respectively (P = 0.048). More patients in the needle group had excellent surgical conditions than the catheter group (89.6% versus 72.9; P< 0.003). We conclude that giving a single-injection dose via the epidural needle before catheter placement improves the quality of epidural anesthesia and reduces catheter-related complications.

Comparative Study of Effects of Administration of Local Anaesthetics Through Epidural Needle Before and After Epidural Catheter Insertion

“…Saline, however, dilutes the local anesthetic injected; in this study, we therefore administered a single-injection dose of local anesthetic (20mL) as a priming solution as done by Cesur et al (5) This study also demonstrated improved surgical conditions with the administration of a single-injection dose through an epidural needle before epidural catheter placement. (5) However, Rolbin et al (8) and Scott and Beilby (9) reported no advantage in injecting fluid into the epidural space before catheter insertion, but they administered much smaller volumes of fluid (3 and 5mL, respectively) for priming. However, Paresthesia during epidural catheter insertion has been reported in up to 60% of parturients, (10) and the frequency of venous and subarachnoid cannulation has been studied and there complications were reported.…”

“…(5) Gadalla et al (6) Mannion et al, (7) all noted a significant reduction in the incidence of extradural vein cannulation by routinely injecting 10 mL of saline priming fluid into the epidural space before catheter insertion. Saline, however, dilutes the local anesthetic injected; in this study, we therefore administered a single-injection dose of local anesthetic (20mL) as a priming solution as done by Cesur et al (5) This study also demonstrated improved surgical conditions with the administration of a single-injection dose through an epidural needle before epidural catheter placement. (5) However, Rolbin et al (8) and Scott and Beilby (9) reported no advantage in injecting fluid into the epidural space before catheter insertion, but they administered much smaller volumes of fluid (3 and 5mL, respectively) for priming.…”

“…Myelographically. (15) We used a multi-port epidural catheter inserted only 4 cm in the epidural space; these catheters give better anesthesia and require less manipulation than uniport ones (4,5) and insertion to no more than 3-4 cm into the epidural space minimizes complications and the incidence of inadequate anesthesia, even in obstetric patients. (16) Our singleinjection dose via epidural needle before catheter placement led to fewer cases of catheter replacement and inadequate anesthesia.…”

“…(5)(6)(7) Some studies contradicted, (8,9) but in studies showing a lack of effect, either a small and possibly inadequate volume of local anesthetic or normal saline, which would dilute local anesthetic subsequently injected, was given. The use of a large priming dose of local anesthetic has not been studied.…”

Lidocaine/ketorolac-loaded biodegradable nanofibrous anti-adhesive membranes that offer sustained pain relief for surgical wounds

“…4 An effective method for the management of postoperative pain after lower abdominal or lower extremity surgery is using epidural analgesia with local anesthetics, but it is a highly techniquedependent and invasive procedure. 5 Adhesion, on the other hand, is a band of scar tissue that binds two parts of tissues or organs together. 6 Adhesions form when the body's repair mechanisms respond to any tissue disturbances, such as surgery, infection, trauma, or radiation.…”