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High quality labour analgesia using small gauge epidural needles and catheters

[Une analgésie de qualité pendant le travail avec l’usage d’aiguilles et de cathéters de petit calibre]

Pamela J. Angle, MD FRCPC MSc^*, Kamal Hussain, MBBS FFARCSI^*, Anwar Morgan, MD FRCPC^*, Stephen H. Halpern, MD FRCPC MSc^*, Martin Van der Vyver, MB FRCP(C)^*, Jennifer Yee, RN^* and Alexander Kiss, PhD

^* From the Departments of Anesthesia, and
Research Design and Biostatistics, Sunnybrook & Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada.

Address correspondence to: Dr. Pamela J. Angle, Department of Anesthesia, Women’s College Campus, Sunnybrook and Women’s College Health Sciences Centre, 76 Grenville Street, Toronto, Ontario M5S 1B2, Canada. Phone: 416-323-6008; Fax: 416-323-6307; E-mail: pamela.angle{at}sw.ca

Purpose: Inadvertent epidural needle punctures represent the leading cause of severe postdural puncture headache (PDPH) in parturients. Use of small gauge (G) epidural needles for continuous analgesia has received little attention despite possible important reductions in PDPH. We report the first study to examine the feasibility of using small G Tuohy needles and 23 G catheters for labour analgesia.

Methods: Healthy parturients 6 cm dilated were recruited. Epidural analgesia was established using a 19 G Tuohy epidural needle, a 23 G single port 40 cm catheter and bupivacaine 0.08% with fentanyl 2 µg·mL^–1 (15–20 mL). Breakthrough pain was treated by protocol. There was no formal in-training period for anesthesiologists. The primary outcome was the combined failure rate for initiation (failed needle/catheter placement or failed block 30 min of drug administration). Secondary out-comes included late block failure (> 30 min), recognized dural puncture, PDPH, patient assessment of analgesia within 24 hr of delivery, complications and anesthesiologist satisfaction.

Results: Twenty-seven parturients were recruited. Successful blocks were initiated and maintained in 24/27 who rated overall analgesia from good to excellent (19/24 very good to excellent). Three block failures occurred at the initiation phase only (two unilateral, one absent). There was no evidence of catheter kinking after placement. One patient developed PDPH after unrecognized dural puncture which was self-treated with acetaminophen for four days, followed by complete symptom resolution.

Conclusion: It is feasible to provide high quality labour analgesia using small G epidural needles and catheters. The effect of small G epidural needles on PDPH warrants future study.