Intrathecal Migration of an Epidural Catheter While Using a Programmed Intermittent Epidural Bolus Technique for Labor Analgesia Maintenance

Betti, Francesca; Carvalho, Brendan; Riley, Edward T.

doi:10.1213/xaa.0000000000000616

Cited by 7 publications

(4 citation statements)

References 13 publications

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“…A potential disadvantage of programmed intermittent epidural bolus is unintentional high neuroblockade that may accompany catheter migration into the intrathecal space. 27…”

Section: Labor Analgesia and Anesthesiamentioning

confidence: 99%

A Review of the Impact of Obstetric Anesthesia on Maternal and Neonatal Outcomes

et al. 2018

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Obstetric anesthesia has evolved over the course of its history to encompass comprehensive aspects of maternal care, ranging from cesarean delivery anesthesia and labor analgesia to maternal resuscitation and patient safety. Anesthesiologists are concerned with maternal and neonatal outcomes, and with preventing and managing complications that may present during childbirth. The current review will focus on recent advances in obstetric anesthesia, including labor anesthesia and analgesia, cesarean delivery anesthesia and analgesia, the effects of maternal anesthesia on breastfeeding and fever, and maternal safety. The impact of these advances on maternal and neonatal outcomes is discussed. Past and future progress in this field will continue to have significant implications on the health of women and children.

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“…A potential disadvantage of programmed intermittent epidural bolus is unintentional high neuroblockade that may accompany catheter migration into the intrathecal space. 27…”

Section: Labor Analgesia and Anesthesiamentioning

confidence: 99%

A Review of the Impact of Obstetric Anesthesia on Maternal and Neonatal Outcomes

et al. 2018

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“…Although our study was too small to assess safety, PCEA may be inherently safer than PIEB if a neuraxial catheter is unintentionally sited in the subarachnoid space [35]. In contrast, in the setting of an intrathecal catheter and PCEA‐only analgesia maintenance, patients will not self‐administer an additional bolus because they will have no pain.…”

Section: Discussionmentioning

confidence: 99%

High‐volume patient‐controlled epidural vs. programmed intermittent epidural bolus for labour analgesia: a randomised controlled study

et al. 2023

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Summary The aim of neuraxial analgesia is to achieve excellent pain relief with the fewest adverse effects. The most recently introduced technique for epidural analgesia maintenance is the programmed intermittent epidural bolus. In a recent study, we compared this with patient‐controlled epidural analgesia without a background infusion and found that a programmed intermittent epidural bolus was associated with less breakthrough pain, lower pain scores, higher local anaesthetic consumption and comparable motor block. However, we had compared 10 ml programmed intermittent epidural boluses with 5 ml patient‐controlled epidural analgesia boluses. To overcome this potential limitation, we designed a randomised, multicentre non‐inferiority trial using 10 ml boluses in each group. The primary outcome was the incidence of breakthrough pain and total analgesic intake. Secondary outcomes included motor block; pain scores; patient satisfaction; and obstetric and neonatal outcomes. The trial was considered positive if two endpoints were met: non‐inferiority of patient‐controlled epidural analgesia with respect to breakthrough pain; and superiority of patient‐controlled epidural analgesia with respect to local anaesthetic consumption. A total of 360 nulliparous women were allocated randomly to patient‐controlled epidural analgesia‐only or programmed intermittent epidural bolus groups. The patient‐controlled group received 10 ml boluses of ropivacaine 0.12% with sufentanil 0.75 μg.ml‐1; the programmed intermittent group received 10 ml boluses supplemented by 5 ml patient‐controlled boluses. The lockout period was 30 min in each group and the maximum allowed hourly local anaesthetic/opioid consumption was identical between the groups. Breakthrough pain was similar between groups (11.2% patient controlled vs. 10.8% programmed intermittent, p = 0.003 for non‐inferiority). Total ropivacaine consumption was lower in the PCEA–group (mean difference 15.3 mg, p < 0.001). Motor block, patient satisfaction scores and maternal and neonatal outcomes were similar across both groups. In conclusion, patient‐controlled epidural analgesia is non‐inferior to programmed intermittent epidural bolus if equal volumes of patient‐controlled epidural analgesia are used to maintain labour analgesia and superior with respect to local anaesthetic consumption.

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“…In most cases, the migration of the catheter is discovered immediately after insertion, either when blood or cerebrospinal fluid is aspirated through the catheter, or when the patient develops a neuromuscular blockade on administration of a test dose of local anesthetic medication. The incidence of an apparently normally functioning epidural catheter moving away from its initial position and resulting in a neurological deficit hours or days after it was initially inserted is much lower and only a few cases have been reported in literature since the first such case, which was reported in 1985 [7][8][9][10].…”

Section: Discussionmentioning

confidence: 99%

Intrapartum Subarachnoid Migration of Epidural Catheter Inserted for Labour Analgesia: A Case Report

Sambhukumar¹,

Mohamed²,

Shankar³

2023

Cureus

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Epidural analgesia is commonly used for pain management during labor. Owing to the blind nature of the insertion of the catheters, they are prone to migration to various spaces intra-spinally, which may result in a multitude of complications. We present a case of a 32-year-old lady who was admitted with labor pain, and an epidural catheter was inserted for labor analgesia. Five hours after insertion, she developed sudden motor and sensory impairment suggestive of subarachnoid migration of the catheter. The diagnosis, management, and risks associated with delay in the identification of this potentially fatal complication are discussed.

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Intrathecal Migration of an Epidural Catheter While Using a Programmed Intermittent Epidural Bolus Technique for Labor Analgesia Maintenance

Cited by 7 publications

References 13 publications

A Review of the Impact of Obstetric Anesthesia on Maternal and Neonatal Outcomes

A Review of the Impact of Obstetric Anesthesia on Maternal and Neonatal Outcomes

High‐volume patient‐controlled epidural vs. programmed intermittent epidural bolus for labour analgesia: a randomised controlled study

Intrapartum Subarachnoid Migration of Epidural Catheter Inserted for Labour Analgesia: A Case Report

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