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Injecting saline through the epidural needle decreases the iv epidural catheter placement rate during combined spinal-epidural labour analgesia

[L’injection de solution saline par l’aiguille péridurale diminue le taux de canulation iv du cathéter péridural pendant l’analgésie rachidienne péridurale combinée pour le travail obstétrical]

Farida Gadalla, MD^*, Sung-Hee Rhim Lee, MD, Kue C. Choi, MD, Jill Fong, MD^*, Matthew C. Gomillion, MD^* and Barbara L. Leighton, MD^*

^* From the Departments of Anesthesiology, Weill Medical College of Cornell University, New York, NY; and
Women and Infants’ Hospital, Providence, RI, USA.

Address correspondence to: Dr. Farida Gadalla, Department of Anesthesiology, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021, USA. Phone: 212-746-2795; Fax: 212-746-8563; E-mail: fgadalla{at}med.cornell.edu

Purpose: To determine if injecting 10 mL saline before epidural catheter threading (pre-cannulation epidural fluid injection) can decrease the incidence of iv epidural catheter placement during combined spinal-epidural (CSE) labour analgesia.

Methods: One hundred healthy women requesting CSE labour analgesia with either fentanyl 20 µg or sufentanil 10 µg were prospectively randomized to receive either no epidural injection (dry group, n = 50) or epidural 10 mL saline injection (saline group, n = 50) before epidural catheter placement. A nylon multiport catheter was then threaded 3–5 cm into the epidural space and the needle was removed. We diagnosed iv catheter placement if blood was freely aspirated, if the mother became tachycardic after injection of epinephrine 15 µg, or if intracardiac air was heard (using ultrasound) after injection of air 1.5 mL.

Results: Intravenous epidural catheter placement occurred in one saline and ten dry group patients (P < 0.01). No complications of excessive cephalad intrathecal opioid spread (i.e., difficulty swallowing, hypoxemia, or respiratory arrest) occurred.

Conclusions: Injecting 10 mL or saline through the epidural needle after intrathecal opioid injection and before threading the catheter significantly decreased accidental venous catheter placement without any apparent increase in complications from excessive cephalad intrathecal opioid spread.

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