Direction of catheter insertion and the incidence of paresthesia during continuous epidural anesthesia in the elderly patients

Abstract

BackgroundContinuous epidural anesthesia is useful for endoscopic urologic surgery, as mostly performed in the elderly patients. In such a case, it is necessary to obtain successful sacral anesthesia, and the insertion of epidural catheter in the caudad direction may be needed. However, continuous epidural catherization has been related to paresthesias. This study aimed to evaluate the effects of the direction of the catheter insertion on the incidence of paresthesias in the elderly patients.MethodsTwo hundred elderly patients scheduled for endoscopic urologic surgery were enrolled. The epidural catheter was inserted at L2-3, L3-4, and L4-5 using the Tuohy needle. In Group I (n = 100), the Tuohy needle with the bevel directed the cephalad during the catheter insertion. In Group II (n = 100), it directed the caudad. During the catheter insertion, an anesthesiologist evaluated the presence of paresthesias and the ease or difficulty during the catheter insertion.ResultsIn Group I (n = 97), 15.5% of the patients had paresthesias versus 18.4% in Group II (n = 98), and there was no significant difference between the two groups. In paresthesia depending on the insertion site and the ease or difficulty during the catheter insertion, there were no significant differences between the two groups.ConclusionsOur results concluded that the direction of epidural catheter insertion did not significantly influence the incidence of paresthesias in the elderly patients.

Acoustic puncture assist device versus loss of resistance technique for epidural space identification

“…Minor complications (venous puncture, nerve root irritation) were similar to that described in literature for either of the group without any statically significant difference. [ 14 15 ]…”