Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-24T07:50:47.504Z Has data issue: false hasContentIssue false
  • English
  • Français

Lumbar epidural catheter insertion: the midline vs. the paramedian approach

Published online by Cambridge University Press:  13 October 2005

M. Leeda ,
R. Stienstra ,
M. S. Arbous ,
A. Dahan ,
B. Th. Veering ,
A. G. L. Burm  and
J. W. Van Kleef
M. Leeda
Affiliation:
Leiden University Medical Center, Department of Anesthesiology, Leiden, The Netherlands
R. Stienstra
Affiliation:
Leiden University Medical Center, Department of Anesthesiology, Leiden, The Netherlands
M. S. Arbous
Affiliation:
Leiden University Medical Center, Department of Anesthesiology, Leiden, The Netherlands
A. Dahan
Affiliation:
Leiden University Medical Center, Department of Anesthesiology, Leiden, The Netherlands
B. Th. Veering
Affiliation:
Leiden University Medical Center, Department of Anesthesiology, Leiden, The Netherlands
A. G. L. Burm
Affiliation:
Leiden University Medical Center, Department of Anesthesiology, Leiden, The Netherlands
J. W. Van Kleef
Affiliation:
Leiden University Medical Center, Department of Anesthesiology, Leiden, The Netherlands
Get access

Extract

Summary

Background and objective: The purpose of this study was to compare the characteristics of epidural catheter insertion via the midline or the paramedian approach with regard to ease of catheter insertion, incidence of paraesthesias and efficacy of epidural block. In addition to the type of approach, the prognostic value of Patients characteristics variables with regard to the incidence of paraesthesias was assessed. Methods: Thirty patients scheduled for surgery under epidural anaesthesia were randomly assigned to one of two groups of 15 patients each. Epidural anaesthesia was performed via a midline or paramedian approach using loss of resistance to saline. Variables measured were: time needed to identify the epidural space, time needed for and ease of epidural catheter insertion and the incidence of paraesthesias. After completion of these observations, epidural anaesthesia was established with 150 mg ropivacaine 1%. Efficacy of the epidural block was assessed by the need for intraoperative analgesics and by the patient on a three-point scale (good/fair/poor). Results: Quality of sensory blockade was adequate in both groups. Catheter insertion was significantly faster using the paramedian approach. The difference between the two approaches with regard to the incidence of paraesthesias was not significant, however, there was a trend towards more paraesthesias in the midline group. In the multivariate analysis, type of approach was an independent significant predictor of paraesthesias and we found a trend towards a higher incidence of paraesthesias in female patients. Conclusions: Catheter insertion was faster in the paramedian group and we found a trend towards a higher incidence of paraesthesias with the midline approach.

Keywords

ANAESTHESIA, EPIDURAL, technique, midline, paramedianGENDERINTRAOPERATIVE COMPLICATIONS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 11 , November 2005 , pp. 839 - 842
Copyright
© 2005 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Rolbin SH, Hew E, Ogilvie G. A comparison of two types of epidural catheters. Can J Anaesth 1987; 34: 459–461.Google Scholar
Scott DA, Beilby DS. Epidural catheter insertion: the effect of saline prior to threading in non-obstetric patients. Anaesth Intens Care 1993; 21: 284–287.Google Scholar
Hetherington R, Stevens RA, White JL, et al. Subjective experiences of anesthesiologists undergoing epidural anesthesia. Reg Anesth 1994; 19: 284–288.Google Scholar
Munoz HR, Dagnino JA, Allende M et al. Direction of catheter insertion and incidence of paresthesias and failure rate in continuous epidural anesthesia: a comparison of cephalad and caudad catheter insertion. Reg Anesth 1993; 18: 331–334.Google Scholar
Blomberg RG. Technical advantages of the paramedian approach for lumbar epidural puncture and catheter introduction. A study using epiduroscopy in autopsy subjects. Anaesthesia 1988; 43: 837–843.Google Scholar
Blomberg RG, Jaanivald A, Walther S. Advantages of the paramedian approach for lumbar epidural analgesia with catheter technique. A clinical comparison between midline and paramedian approaches. Anaesthesia 1989; 44: 742–746.Google Scholar
Hosmer DW. Model building strategies. In: Hosmer DW, Lemeshow S, eds. Applied Logistic Regression, 2nd edn. New York, USA: John Wiley & Sons, 2000: 91–142.
Jaucot J. Paramedian approach of the peridural space in obstetrics. Acta Anaesthesiol Belg 1986; 37: 187–192.Google Scholar
Kopacz DJ, Neal JM, Pollock JE. The regional anesthesia ‘learning curve’: What is the minimum number of epidural and spinal blocks to reach consistency? Reg Anesth Pain Med 1996; 21: 182–190.Google Scholar
Sprung J, Bourke DL, Grass J et al. Predicting the difficult neuraxial block: A prospective study. Anesth Analg 1999; 89: 384–389.Google Scholar