Epidural catheter fixation: subcutaneous tunnelling with a loop to preventdisplacement

A method of fixing the epidural catheter by subcutaneous tunnelling and loo ping was devised. A prospective, randomised, double-blind, clinical trial w as conducted in 68 adult patients, where postoperative pain relief was plan ned by thoracic epidural analgesia. In the tunnelled group (n = 34), the ep idural catheter was fixed with a subcutaneous tunnel and loop, whereas in c ontrols (n = 34), a simple loop of epidural catheter was left over the skin without tunnelling. An adhesive dressing was used to secure the epidural c atheter. We observed that catheter dislodgement occurred in only one patien t in the tunnelled group compared to seven control patients (21%). Despite local inflammation of the skin around the tunnel in nine patients (27%), no catheter infection (positive culture tip) was found in patients with subcu taneous tunnelling for the extended period of 4-5 days. The method describe d allows the catheter to lie flat on the skin and outward traction of the c atheter during movement of patients is dampened by the interposed loop whic h protects it against dislodgement. At the time of removal, both ends of th e catheter can be removed under direct vision. In conclusion, we recommend this fixation method in cases where epidural analgesia is to be used for po stoperative pain relief.