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The lateral recumbent head-down position decreases the incidence of epidural venous puncture during catheter insertion in obese parturients

[La position de Trendelenburg latéral diminue l’incidence de ponction veineuse épidurale pendant l’insertion d’un cathéter chez des parturientes obèses]

Murat Bahar, MD^*, Michael Chanimov, MD PhD^*, Mathias L. Cohen, MB CHB^*, Mark Friedland, MD^*, Ina Shul, MD^*, Vladislav Gofman, MD^*, Shlomo Gershfeld, MD^*, Rima Geller, MD^* and Dan J. Sherman, MD

^* From the Departments of Anesthesiology, and
Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Address correspondence to: Dr. Murat Bahar, Department of Anesthesiology, Assaf Harofeh Medical Center, Zerifin 70300, Israel. Phone: +972-8-9977466; Fax: +972-8-9779459; E-mail: anesthesia{at}asaf.health.gov.il

Purpose: The unintentional and unrecognized cannulation of an extradural vein is a potentially serious complication of an epidural anesthetic. The present study was undertaken to assess the incidence of blood vessel puncture related to epidural catheterization in three different body positions, in a cohort of morbidly obese parturients, following the completion of a similar study published in 2001 from which such parturients were excluded.

Methods: The study was conducted in 450 (three groups of 150) morbidly obese, obstetric patients undergoing continuous epidural analgesia during labour. Epidural catheterization was performed on patients randomized to the sitting, lateral recumbent horizontal, or lateral recumbent head-down position.

Results: There was a lower incidence of vessel cannulation when this procedure was performed in the lateral recumbent head-down position [1.3%; body mass index (BMI): 37.0] than in the lateral recumbent horizontal [12.9%; BMI: 38.0] and in the sitting position [12.0%; BMI: 38.0]. The incidence of accidental subarachnoid puncture was 2%, 1.3% and 2% respectively, in these same positions.

Conclusion: Adoption of the lateral recumbent head-down position for the performance of lumbar epidural blockade, in labour at term, reduces the incidence of lumbar epidural venous puncture in these obese parturients.

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