Cannulation of the Epidural Space A Comparison of 18− and 16-Gauge Needles

McNeill, M. J.

doi:10.1097/00132582-198810000-00005

Cited by 9 publications

(8 citation statements)

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“…epidural analgesia [20]. In no case were there any clinical signs of local anaesthetic toxicity that could be attributed to either direct vascular injection or rapid absorption of the local anaesthetic solution.…”

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confidence: 92%

Paravertebral blockade

et al. 1995

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SummaryThe failure rate and complications were studied prospectively in 367paediatric and adult patients who had received a thoracic or lumbar paravertebral block. The overall failure rate was 10.1 YO; adults 10.7%; children 6.2%. The frequency of complications were: hypotension: 4.6%; vascular puncture: 3.8%; pleural puncture: 1 . 1 %; pneumothorax: 0.5%. Since these results are similar to those found with alternative methods, e.g. epidural, intrapleural and intercostal blocks, paravertebral block can be recommended as an effective, safe technique for unilateral analgesia in both adults and children.

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confidence: 92%

Paravertebral blockade

et al. 1995

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“…Other series range from 5% 7 to 18%. 8 The study is not large enough to comment on major complications associated with GP-administered epidurals. Larger quality assurance studies will need to be done in future.…”

Section: Resultsmentioning

confidence: 99%

A Five-Year Prospective Analysis of the Efficacy, Safety and Morbidity of Epidural Anaesthesia Performed by a General Practitioner Anaesthetist in an Isolated Rural Hospital

Watts¹

1992

Anaesth Intensive Care

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During ajive-year period, 324 epidurals were performed by a general practitioner anaesthetist in an isolated rural hospital. Of these 160 were for obstetric purposes, 72% in primagravida patients, the majority in early and established labour (median cervical dilatation of 3.0 cm). The median epidural insertion time was seven minutes: 80% were free of all complications, there were no dural taps and there was a failure rate of 2%. The median visual analogue pain score (VAPS) was 8.3 prior to insertion and at peak of epidural blockade it was reduced to 0.5. Ten per cent of patients had unblocked segments, half of these were corrected and 90% of patients had even blocks. Despite higher pain scores in the 6-10 cm cervical dilatation group, epidural analgesia was just as effective when compared to the 0.5 cm group. Seventy-seven percent of women interviewed the day after delivery were fully satisjied with the epidural: 19% said it was considerable help, 2% some help and 2% said no help at all. During epidural caesarean section (n = 72), 75% of patients were comfortable, 17% had some discomfort and 7% required general or spinal anaesthesia. The incidence of hypotension (systolic blood pressure < 90 mmHg), was 24.6% with a median ephedrine dose of 10 mg; however, with a greater than 20% drop in systolic blood pressure, the dose of ephedrine required to maintain blood pressure increased in a log-dose fashion. For women who received epidurals in labour, the caesarean section rate was 25%, instrumental vaginal delivery 34% and spontaneous vaginal delivery 41 %. There were no adverse neonatal outcomes.

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“…(8,16) Suboptimal positioning of the epidural catheter is common. Both the type of catheter and needle (19) and its optimal depth of insertion have been questioned. Lim et al (20) found that the catheter tip could be advanced without coiling for 4cm or less in only 13% of cases.…”

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confidence: 99%

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

Ramtani¹,

Tarkase²,

Cham³

2015

jemds

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Epidural catheter placement offers flexibility in block management. However, during epidural catheter insertion, complications such as paresthesias, venous and subarachnoid cannulation, suboptimal catheter placement and coiling of catheter can affect the quality of anesthesia. A prospective randomized controlled study was conducted to assess the effect of priming of epidural space with a single-injection dose of local anesthetic solution (10mL 2% lidocaine+ adrenaline and 10ml 0.5% bupivacaine) before catheter insertion. We randomized 100 patients into 2 equal groups and measured the quality of anesthesia and incidence of catheter related complications. METHODS: A group of 100 patients was randomized and divided in two groups. In Group A [needle group] (n _ 50), local anaesthetic solution was administered through epidural needle before epidural catheter insertion. In Group B [catheter group] (n _ 50), the catheter was inserted immediately after identification of the epidural space. Local anesthetic solution was then injected via the catheter. We noted the occurrence of paresthesia, inability to advance the catheter, or IV or subarachnoid catheter placement, number of attempts to insert catheter. Sensory and motor block were assessed 20 min after the injection of local anesthetic solution. Surgery was initiated when adequate sensory loss was confirmed. Infraumbilical, pelvic general surgeries, hysterectomies and lower limb orthopedic surgeries were included in study. RESULTS: All observations were noted and statistical test of significance was applied. In the catheter group, the incidence of paresthesia during catheter placement was 16% compared with 4% in the needle group (x 2 =4.0, P<0.05). Intravascular catheter placement occurred in 8% versus 0% of patients in the catheter and needle groups, respectively (x 2 = 5.34, P<0.05). The number of attempts to pass catheter was more than one in catheter group as compared to needle group. (x 2 =4.33, P<0.05) More patients in the needle group had excellent quality of surgical conditions than the catheter group (94% versus 35%) (x 2 =9.75, P<0.05). CONCLUSION: We conclude that priming of epidural space with a single injection local anaesthetic dose via the epidural needle before catheter placement improves the quality of anesthetic blockade and reduces catheter-related complications.

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Cannulation of the Epidural Space A Comparison of 18− and 16-Gauge Needles

Cited by 9 publications

References 0 publications

Paravertebral blockade

Paravertebral blockade

A Five-Year Prospective Analysis of the Efficacy, Safety and Morbidity of Epidural Anaesthesia Performed by a General Practitioner Anaesthetist in an Isolated Rural Hospital

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

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