Prevention of Epidural Catheter Migration and Inflammation by Tunneling: A Systematic Review and Meta-Analysis

Background/Objectives: This systematic review and meta-analysis evaluated the efficacy of tunneling as a fixation technique of epidural catheters on catheter migration and infection compared to conventional fixation techniques. Methods: All studies comparing any epidural tunnel fixation technique with any conventional epidural fixation technique (any technique, e.g., adhesive tape) were included, with the exclusion of the obstetric population and the exclusion of caudal anesthesia. MEDLINE and Embase were searched on 18 April 2025 to identify these studies. To evaluate the risk of bias in the selected studies, the Risk of Bias assessment tool from the Cochrane Handbook was used. Risk ratios (RRs) with 95% confidence intervals (CIs) were determined to describe the difference in migration and infection between the two groups. Results: Eleven studies, with a total number of 23,695 patients, were included in this systematic review. Pooled data of the nine studies reporting data on migration showed that tunneling reduced the incidence of inward migration (RR, 0.33; 95% CI, 0.19 to 0.55; n = 613; p < 0.0001; I2 = 0%) but not outward migration (RR, 0.60; 95% CI, 0.25 to 1.43; n = 745; p = 0.25; I2 = 77%). Pooled data from the nine studies on the incidence of infection revealed no statistically significant group difference. Conclusions: Tunneling of the epidural catheter as a fixation technique reduces the risk of inward migration compared to conventional fixation methods. However, for outward migration, tunneling does not reduce the risk of infection. There is a large heterogeneity in fixation methods described in the literature. In summary, this first comprehensive systematic review and meta-analysis corroborates only part of the benefits widely ascribed to epidural catheter tunneling.