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Comparison of three catheter sets for continuous spinal anesthesia in patients undergoing total hip or knee
R Puolakka1, M T Pitkänen, P H Rosenberg
1Department of Anaesthesiology, Helsinki University Central Hospital, Töölö Hospital, Topeliuksenkatu 5, FIN-00029 HYKS, Helsinki, Finland.
Background And Objectives:
Continuous spinal anesthesia (CSA) with microcatheters may be complicated because of technical problems. In elderly patients, some of the problems may be solved by using thicker catheters. A recent invention, involving a catheter-over-needle system, may prevent leakage of cerebrospinal fluid (CSF) and may also improve the prediction of the intrathecal position of the catheter tip.
Methods:
This study included 90 patients undergoing primary hip or knee replacement, randomly allocated into 3 groups, with 30 patients in each group: Group EC, a 24-gauge epidural catheter through a 19-gauge Tuohy needle; group MC, a 28-gauge microcatheter through a 22-gauge spinal needle; group SC, a 22-gauge spinal catheter over a 27-gauge spinal needle through an epidurally placed 18-gauge Crawford needle. All subarachnoid catheterizations were performed with the patient in the lateral position and the initial spinal block dose was 2 mL of plain 0.5% bupivacaine. Increments of 0.5 mL were administered when required. The block performance characteristics were recorded, and the level of analgesia was studied in a blinded fashion. Catheter function during the postoperative infusion was assessed. Afterwards the needles and catheters were examined by microscopy.
Results:
The frequency of the successful catheterization was higher in the EC and MC groups (90% in each) than in the SC group (63%) (P <.05). The mean duration of the successful catheterizations, as well as the median level of analgesia, were similar in the groups. The postoperative infusion had to be stopped in 3, 1, and 1 patients in groups EC, MC, and SC, respectively, because of a technical reason. No neurologic sequelae occurred in this study. Microscopy showed 4 distorted spinal needle tips (2 each with MC and SC) and minor material damage of the SC catheters when bone had been met during block performance.
Conclusions:
Placement of the SC catheters was unsuccessful to a high degree, and bone contact produced distortion of the tip of some of these catheters. Otherwise, the quality associated with catheterization time, anesthetic distribution, and catheter function was similar with the 3 catheters.