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Parturient's posture during epidural puncture affects the distance from skin to epidural space
1Department of Anesthesia and Intensive Care, Hôpital Antoine Béclère, Clamart, France.
Study Objective:
To assess the factors affecting the distance from skin to epidural space.
Design:
Prospective observational study of consecutive cases over a 2-year period.
Setting:
Inpatient obstetric unit in a French university hospital.
Patients:
2,123 consecutive term parturients who received epidural anesthesia for cesarean section or epidural analgesia for labor and vaginal delivery.
Interventions:
At the time of epidural puncture, the interspace used and the patient's posture (sitting or left lateral decubitus) were recorded, and the distance from the skin to the epidural space (DS-ES) was measured to the nearest 0.5 cm using a marked epidural needle.
Measurements And Main Results:
The relationship between patient factors [height, weight, body mass index (BMI; weight/height2), presence of scoliosis] and technical factors (interspace, patient's posture at puncture) versus DS-ES was investigated using multiple regression analysis. DS-ES correlated positively with the parturient's weight and BMI. In addition, DS-ES was significantly greater when epidural puncture was performed in the lateral position as compared with the sitting position.
Conclusion:
Both the patient's weight and position during epidural needle placement are important factors influencing DS-ES. A change from the sitting to the lateral position may increase DS-ES, causing catheter dislodgment and consequent inadequate analgesia. Clinical studies relating DS-ES to inadequate analgesia must take these factors into account.