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Difficulty in Advancing Flexible Epidural Catheters When Establishing Labor Analgesia: An Observational Open-Label
Carlo Pancaro1, Jasmine Purtell1, Dana LaBuda1
1From the Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
Anesthesia and Analgesia
|April 9, 2021
Summary
The multiorifice epidural catheter demonstrated superior first-attempt insertion success compared to the single-end hole catheter, reducing labor analgesia complications. This highlights the importance of catheter design in epidural procedures.
Area of Science:
- Anesthesiology
- Biomedical Engineering
- Obstetrics
Background:
- Flexible epidural catheters can be difficult to advance through Tuohy needles, potentially increasing labor analgesia complications.
- This study addresses challenges in advancing flexible epidural catheters during labor epidural analgesia.
- Investigates catheter advancement through different epidural needles from common kits.
Purpose of the Study:
- To compare the first-attempt insertion success rates of two different flexible epidural catheters.
- To determine if catheter design impacts the ease of advancement through epidural needles for labor analgesia.
- To evaluate the influence of catheter morphology on the success of epidural placement.
Main Methods:
- An open-label clinical trial involving 240 laboring patients randomized to two epidural kits (120 each).
- Compared a single-end hole wire-reinforced polyurethane catheter (A) with a multiorifice wire-reinforced polyamide nylon blend catheter (B).
- Assessed the primary outcome of failure to advance the epidural catheter and recorded needle manipulations; engineering properties were determined.
Main Results:
- Catheter A (single-end hole) failed first-attempt advancement in 15% of patients versus 0.8% for Catheter B (multiorifice) (P < .0001).
- Catheter A required significantly more needle manipulations (25) than Catheter B (1) (P < .0001).
- Catheter B exhibited greater bending stiffness (1.28 N·mm²) than Catheter A (0.64 N·mm²), with a less acute needle-catheter angle.
Conclusions:
- The multiorifice, wire-reinforced polyamide nylon blend epidural catheter (B) demonstrated a significantly higher success rate for first-attempt advancement.
- Inability to advance the catheter was more frequent with the single-end hole polyurethane catheter (A).
- Variations in epidural needle and catheter morphology significantly influence the success of labor epidural analgesia placement.
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