Treatment of Incomplete Analgesia after Placement of an Epidural Catheter and Administration of Local Anesthetic for Women in Labor 

Abstract

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.

Dural puncture epidural analgesia for labor: a randomized comparison between 25-gauge and 27-gauge pencil point spinal needles

“…Pain was evaluated using an 11-point NRS (from 0 to 10) where 0 represented no pain and 10, the worst imaginable pain. A previous trial pertaining to labor analgesia9 reported that patients with NRS ≤1 rarely requested extra analgesic interventions. Thus, in the current study, the primary outcome, onset time, was defined as the time elapsed between the end of LA injection through the epidural catheter and an NRS level ≤1 (5).…”

Advancing an epidural catheter 10 cm then retracting it 5 cm is no more effective than advancing it 5 cm

“…One patient in the 10-cm group had the catheter located intravascularly when placed 10 cm into the space but was not intravascular when it was retracted 5 cm. Although many anesthesiologists are concerned about retracting an epidural catheter when it is located intravascularly, this practice has been described in the literature [3]. The concern is that the catheter may remain intravascular despite having been retracted, placing the parturient at risk for local anesthetic toxicity.…”

Repeated failure of epidural analgesia: An association with epidural fat?☆

“…Surgical management may involve multiple level laminectomies and decompression 16,18 or endoscopic suction decompression via small bilateral laminotomies. 21 We hypothesize in our patient that the extensive accumulation of epidural fat adversely affected the distribution of the drugs we administered in the Prevent migration from epidural space by ensuring catheter is inserted an optimal distance (4-6 cm) 25 and is well secured 26 Paraspinal muscle/fat 5 Tsui test 13 and epidural local anesthetic test dose to confirm placement and to Paravertebral 7,22 try to reestablish analgesia Interpleural 8 Replace catheter or choose alternative analgesic regimen Intravascular 23,24 Catheter is in the epidural space, but is not providing adequate analgesia Catheter in anterior epidural space 1, 27 Tsui test 13 /local anesthetic test dose may help identify where catheter is Catheter in lateral epidural space 2 Reposition* catheter by pulling it back 24,47,48 Catheter or solution migrates out intervertebral foramen 2,14,[28][29][30][31] Change programming parameters (e.g., increase bolus 11 dose and/or infusion rate 58 45,46 *Controversial issue (pro and con).…”