The frequency of mosaic epidural block during labour. The comparison of two kinds of epidural catheters
Keywords:incomplete epidural block, epidural analgesia in labour
It is assumed that the design of the epidural catheter may affect the quality of analgesia. Two types of epidural catheters were compared – three and six side perforation holes at the end, and the incidence of incomplete block.
The study included 308 pregnant women who underwent epidural labour analgesia. Group A (Gr. A) included 271 pregnant women in which the epidural catheter with three side holes has been used and group B (Gr. B) included 50 pregnant women in which epidural catheter with six side holes has been used. The incidence of incomplete sensory block to the right or left half of the body was evaluated.
It was found that the incidence of incomplete epidural block in patients of Gr. A constituted 31,4 % (n = 81) and in Gr. B – 6 % (n = 3), p = 0.001. There was no statistically significant correlation on age, weight, height and body mass index with incidence of incomplete epidural block. With the development of an incomplete epidural block caesarean section rates did not differ between groups.
Using an epidural catheter with six side holes at the end helps to reduce the incidence of incomplete block in epidural analgesia in labour.
Andersen G. Postoperative pain control by epidural analgesia after transabdominal surgery. Efficacy and problems encountered in daily routine / G. Andersen, H.Rasmussen, C.Rosenstock // Acta Anaesthesiol Scand. – 2000. – Vol. 44. – P. 296–301.
Beilin Y. Quality of analgesia when air versus saline is used for identificationof the epidural space in the parturient / Y. Beilin, I. Arnold, C.Telfeyan // Reg. Anesth. Pain Med. – 2000. – Vol. 25. – P. 596–599.
Bromage P.R. Epidural analgesia in obstetrics. Philadelphia: WB. Saunders. – 1978. – P. 558–9.
Dalens B. Epidural bubbles as a cause of incomplete analgesia during epidural anesthesia / B.Dalens, J.Bazin, J.Haberer//Anesth. Analg. – 1987. – Vol. Vol. 66. – P. 678–683.
Davies M.W., Harrison J.C., Ryan T.D.R. Current practice of epidural analgesia during normal labour. A survey of maternity units in the United Kingdom / M.W.Davies, J.C.Harrison, T.D.R.Ryan // Anesthesia. – 1993. – Vol.48. – P. 63–66.
Dickson M.A. Comparison of single, end-holed and multi-orifice extradural catheters when used for continuous infusion of local anaesthetic during labour / M.A.Dickson, C.Moores, J.H.McClure // Br J Anaesth. – 1997. – Vol. 79. – P.297–300.
Dogliotti A.M. A new method of block anesthesia. Segmental peridural spinal anesthesia // Am J Surg. – 1933. – Vol.20: 107–118.
Howell T.K. A change in resistance? A survey of epidural practice amongst obstetric anaesthetists? / T.K.Howell, D.P.Prosser, M.Harmer // Anaesthesia. – 1998. – Vol. 53. – P. 238–243.
Hauth J.C. Uterine contraction pressures with oxytocin induction/augmentation / J. C. Hauth, G.D.Hankins, L. C. Gilstrap. 3rd., D. M. Strickland P.Vance // Obstet Gynecol. – 1986. – Vol. 68. – P. 305–309.
Morrison L.M. Comparison of complications associated with single-holed and multi-holed extradural catheters / L.M.Morrison, A.S.Buchan // Br J Anaesth. – 1999. – Vol. 64. – P.183–5.
Michael S. A comparison between open-end (single hole) and closedend (three lateral holes) epidural catheters. Complications and quality of sensory blockade / S.Michael, M.N.Richmond, R.J.Birks // Anaesthesia. – 1989. – Vol. 44. – P. 578–80.
Michael S.A comparison between open-end (single hole) and closed-end (three lateral holes) epidural catheters. Complications and quality of sensory blockade / S.Michael, M.N.Richmond, R.J.Birks // Anaesthesia. – 1989. – Vol. 44. – P. 578–80.
Okutomi T. Epidural saline solution prior to local anesthetic solution produces differential nerve block / T.Okutomi, S.Hoka // Can J Anaesth. – 1998. – Vol. 45. – P. 1091–1093.
Paech M.J. Complications of obstetric epidural analgesia and anaesthesia: a prospective analysis of 10995 cases / M.J.Paech, R.Godkin, S.Webster // Int J Obstet Anesth. – 1998. – Vol. 7. – P. 5–11.
Portnoy D. Mechanisms and management of an incomplete epidural block for cesarean section / D.Portnoy, R.B.Vadhera // Anesthesiology Clin N Am. – 2003. – Vol. 21. – P. 39–57.
Segal S. Superiority of multi-orifice over single-orifice epidural catheters for labor analgesia and cesarean delivery / S.Segal, S.Eappen, S.Datta // J Clin Anesth. – 1997. – Vol. 9. – P. 109–12.
Saberski L.R. Identification of the epidural space: Is loss of resistance to air a safe technique? A review of the complications related to the use of air / L.R.Saberski, S.Kondamuri, O.Y.Osinubi // Reg Anesth Pain Med. – 1997. – Vol. 22. – P. 3–15.
Tanaka K. Extensive application of еpidural anesthesia and analgesia in a university hospital: Incidence of complications related to technique / K.Tanaka, R.Watanabe // Reg Anesth Pain Med. – 1993. – Vol. 18. – P. 34–38.
Ready L.B. Acute pain: lessons learned from 25,000 patients. Reg Anesth Pain Med. – 1999. – Vol. 24. – P. 499–505.
Van De Velde M. Identification of the epidural space: Stop using the loss of resistance to air technique! Acta Anaesth. Belg. – 2006. – Vol. 57. – P. 51–54.
Valentine S.J. Comparative study of the effects of air or saline to identify the extradural space / S.J.Valentine, A.P.Jarvis, L.E.Shutt // Br J Anaesth. – 1991. – Vol. 66. – P. 224–227.
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