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Confirmation of epidural catheter placement using nerve stimulation
B C Tsui1, S Gupta, B Finucane
1Department of Anaesthesia, University of Alberta Hospitals, Walter Mackenzie Health Sciences Centre, Edmonton, Canada.
Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|August 26, 1998
Summary
Low current electrical epidural stimulation reliably confirms epidural catheter placement. This objective technique offers high sensitivity and specificity, simplifying post-operative pain management procedures.
Area of Science:
- Anesthesiology
- Pain Management
- Neurosurgery
Background:
- Accurate epidural catheter placement is crucial for effective post-operative pain management.
- Confirming correct placement traditionally relies on test doses, which may have limitations.
Purpose of the Study:
- To evaluate the reliability of low current electrical epidural stimulation for confirming epidural catheter placement.
- To assess the sensitivity, specificity, and predictive values of this technique.
Main Methods:
- Forty patients with existing epidural catheters underwent stimulation using a nerve stimulator (1 Hz, 1-10 mA).
- Catheter placement was determined by observing truncal or limb movement.
- Results were compared against a standard lidocaine test dose.
Main Results:
- The electrical stimulation test demonstrated 100% sensitivity and 91.6% specificity for confirming epidural catheter placement.
- Positive and negative predictive values were 96% and 100%, respectively.
- The test also showed high predictive value for the clinical effect of epidural morphine.
Conclusions:
- Low current electrical epidural stimulation is a simple, objective, and reliable method for confirming epidural catheter placement.
- This technique enhances the safety and efficacy of epidural analgesia.
