DIRECTION OF CATHETER INSERTION AND INCIDENCE OF PARESTHESIAS AND FAILURE RATE IN CONTINUOUS EPIDURAL-ANESTHESIA - A COMPARISON OF CEPHALADAND CAUDAD CATHETER INSERTION

Background and Objectives. Paresthesias and unblocked segments during continuous epidural anesthesia-sometimes leading to higher doses of lo cal anesthetics-can increase the risk of this technique. A cephalad in sertion of the epidural catheter might decrease the incidence of these problems, but this has not been evaluated before in a controlled stud y. Methods. In a prospective, double-blind, randomized study, we compa red the incidence of paresthesias during catheter insertion and the fa ilure rate of continuous epidural anesthesia in two groups of obstetri c patients. In group 1 (n = 52), the Tuohy needle bevel was directed c ephalad during catheter insertion. In group 2 (n = 53), it was directe d caudad. The catheter was introduced 4-5 cm into the epidural space, and bupivacaine 25 mg plus fentanyl 50 mug were administered through i t. Results. Twenty percent of the patients in group 1 had paresthesias versus 40% in group 2 (p = 0.0249-; 95% confidence interval of the di fference 1-40%); intensity of paresthesias was greater in group 2. Pai n relief was complete in 75% and 80% of the patients in groups 1 and 2 , respectively (NS); three patients in group 1 and one in group 2 had unblocked segments (NS). Conclusions. Our results support the contenti on that the catheter should be directed cephalad during insertion for continuous epidural anesthesia.