Lateral recumbent head-down posture for epidural catheter insertion reduces intravascular injection

Purpose: The unintentional and unrecognized cannulation of an extradural ve in is a potentially serious complication of an epidural anesthetic. The pre sent study was undertaken to assess the incidence of blood vessel puncture related to epidural catheterization performed in three different body posit ions. Methods: The study was conducted in 900 (three groups of 300) obstetric pat ients undergoing continuous epidural analgesia during their labour and who were randomly allocated to three groups. Epidural catheterization was perfo rmed with patients in the sitting, lateral recumbent horizontal, or lateral recumbent head-down position. Results: There was a lower incidence of vessel cannulation when this proced ure was performed in the lateral recumbent head-down position (2%) than in the lateral recumbent horizontal (6%) and in the sitting position (10.7%). Conclusion: Adoption of the lateral recumbent head-down position for the pe rformance of lumbar epidural blockade, in labour at term, reduces the incid ence of lumbar epidural venous puncture.