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Fredrickson MJ. Randomised Comparison of an End-Hole, Triple-Hole and Novel Six-Hole Catheter for Continuous Interscalene Analgesia. Anaesth Intensive Care 2019; 42:37-42. [DOI: 10.1177/0310057x1404200108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- M. J. Fredrickson
- Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland and Auckland Southern Cross Hospital Group, Auckland, New Zealand
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Novello-Siegenthaler A, Hamdani M, Iselin-Chaves I, Fournier R. Ultrasound-guided continuous femoral nerve block: a randomized trial on the influence of femoral nerve catheter orifice configuration (six-hole versus end-hole) on post-operative analgesia after total knee arthroplasty. BMC Anesthesiol 2018; 18:191. [PMID: 30567487 PMCID: PMC6300902 DOI: 10.1186/s12871-018-0648-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiorifice catheters have been shown to provide superior analgesia and significantly reduce local anesthetic consumption compared with end-hole catheters in epidural studies. This prospective, blinded, randomized study tested the hypothesis that, in continuous femoral nerve block (CFNB) under ultrasound guidance, multiorifice catheter would reduce local anesthetic consumption at 24 h compared with end-hole catheter. METHODS Eighty adult patients (aged ≥18 years) scheduled to undergo primary total knee arthroplasty under a combination of CFNB, sciatic nerve block and general anesthesia were randomized to CFNB using either a 3-pair micro-hole (Contiplex, BRAUN®, 20G - 400 mm) or an end-hole (Silverstim VYGON®, 20G - 500 mm) catheter. Once the femoral catheter was sited, a bolus of 20 mL lidocaine 1% was injected. An electronic pump then delivered an automated 5 mL bolus of ropivacaine 0.2% hourly, with 10 mL self-administered patient controlled analgesia boluses. RESULTS There was no inter-group difference in either median number of ropivacaine boluses on demand during the first 24 h (4(2-7) vs. 4(2-8) in six-hole and end-hole groups, respectively; P = 0.832) or median ropivacaine consumption at 48 h (365(295-418) vs. 387(323-466); P = 0.452). No significant differences were recorded between the groups at 24 h regarding median average verbal rate pain scale (2(0-3) vs. 2(0-4); P = 0.486) or morphine consumption (0(0-20) vs. 0(0-20); P = 0.749). Quadriceps muscle strength declined to 7% (0-20) and 10% (0-28) in the six-hole and end-hole groups, respectively, at 24 h after surgery (P = 0.733). CONCLUSIONS In this superiority trial, catheter orifice configuration did not influence the effectiveness of CFNB in this setting: quality of analgesia was similar, with no reduction in either local anesthetic or morphine consumption, and equivalent postoperative quadriceps weakness. TRIAL REGISTRATION Retrospectively registered at ( NCT03376178 ). Date: 21 November 2017.
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Affiliation(s)
- Alessandra Novello-Siegenthaler
- Department of Anesthesiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva 14, Switzerland
| | | | - Irène Iselin-Chaves
- Department of Anesthesiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva 14, Switzerland
| | - Roxane Fournier
- Department of Anesthesiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva 14, Switzerland.
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Fredrickson MJ, Ball CM, Dalgleish AJ. Catheter Orifice Configuration Influences the Effectiveness of Continuous Peripheral Nerve Blockade. Reg Anesth Pain Med 2011; 36:470-5. [DOI: 10.1097/aap.0b013e318228d4ce] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Servin M, Mhyre J, Greenfield M, Polley L. An observational cohort study of the meniscus test to detect intravascular epidural catheters in pregnant women. Int J Obstet Anesth 2009; 18:215-20. [DOI: 10.1016/j.ijoa.2008.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2008] [Indexed: 10/20/2022]
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Spiegel JE, Vasudevan A, Li Y, Hess PE. A randomized prospective study comparing two flexible epidural catheters for labour analgesia. Br J Anaesth 2009; 103:400-5. [PMID: 19561345 DOI: 10.1093/bja/aep174] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous studies evaluating stiff epidural catheters found that the three-holed design provided superior labour analgesia compared with an end-holed design. This was believed due to improved medication distribution. Recently, flexible epidural catheters with both designs have been shown to be superior to the stiff epidural catheters. We investigated the success of labour analgesia comparing the flexible three-holed with the flexible end-holed epidural catheter. METHODS This was a prospective, single-blinded randomized study. We enrolled 500 parturients in active labour. The primary outcome was complete relief of labour pain assessed at 30 min. We also assessed the occurrence of paresthesias, intravascular and intrathecal placement, catheter replacement, and treatment of breakthrough pain during labour. Comparisons were made using Pearson's chi(2), with significance determined at the 0.05 level. RESULTS Four hundred and ninety-three subjects completed the study. Initial analgesia was similar (complete labour analgesia: end-holed=85% vs 80% 95% CI of difference: 13% to -3%; P=NS). The incidence of paresthesia was similar (end-holed=3.6% vs 5.3%; P=NS). There was one intrathecal and three intravascular catheters in the three-holed group and two intravascular catheters in the end-holed group. The number of supplemental boluses and catheter replacements required during labour was similar between the groups. CONCLUSIONS There were no differences in the initial analgesia success rate, complications, or labour analgesia between end-hole vs multi-hole flexible epidural catheters.
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Affiliation(s)
- J E Spiegel
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconness Medical Center, Feld. 407 East Campus, 330 Brookline Avenue, Boston, MA 02215, USA.
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Mhyre JM, Greenfield MLVH, Tsen LC, Polley LS. A systematic review of randomized controlled trials that evaluate strategies to avoid epidural vein cannulation during obstetric epidural catheter placement. Anesth Analg 2009; 108:1232-42. [PMID: 19299793 DOI: 10.1213/ane.0b013e318198f85e] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In this systematic review, we evaluated the evidence for seven strategies which have been proposed to minimize the incidence of epidural vein cannulation during lumbar epidural catheter placement in pregnant women. METHODS Multiple databases were searched to identify prospective, randomized, controlled trials between December 1966 and October 2007 that evaluated methods to avoid epidural vein cannulation after lumbar epidural catheter placement in pregnant women. Published trials were evaluated using a quality assessment tool, and results were combined to evaluate efficacy to prevent epidural vein cannulation. RESULTS Of 90 trials screened, 30 trials were included (n = 12,738 subjects). Five strategies reduce the risk of epidural vein cannulation: the lateral as opposed to sitting position (six trials, mean (sd) quality score = 35% [11%], odds ratio (OR) 0.53 [95% confidence interval (CI) 0.32-0.86]), fluid administered through the epidural needle before catheter insertion (8 trials, quality score 48% [18%], OR 0.49 [95% CI 0.25-0.97]), single rather than multiorifice catheter (5 trials, quality score 30% [6%], OR 0.64 [95% CI 0.45-0.91]), a wire-embedded polyurethane compared with polyamide epidural catheter (1 trial, 31%, plus 4 unscored abstracts, OR 0.14 [95% CI 0.06-0.30]) and catheter insertion depth < or =6 cm (2 trials, 47% [11%], OR 0.27 [95% CI 0.10-0.74]). The paramedian as opposed to midline needle approach and smaller epidural needle or catheter gauges do not reduce the risk of epidural vein cannulation. CONCLUSION The risk of intravascular placement of a lumbar epidural catheter in pregnancy may be reduced with the lateral patient position, fluid predistension, a single orifice catheter, a wire-embedded polyurethane epidural catheter and limiting the depth of catheter insertion to 6 cm or less. In general, low manuscript quality weakens the strength of these conclusions.
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Affiliation(s)
- Jill M Mhyre
- Department of Anesthesiology, University of Michigan Health System, Obstetric Anesthesiology Room L3622 Women's Hospital, 1500 E. Medical Center Dr. SPC 5278, Ann Arbor, MI 48109-5278, USA.
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Abstract
Intravascular placement of an epidural catheter is recognised as a potentially fatal complication of epidural anaesthesia and analgesia. Up to 10% of epidural catheters may be inserted into an epidural vessel, the majority of which will be recognised; however, a proportion (1% of all epidural catheters inserted) may not be identified as lying intravascularly. Opinions differ on the optimal method for identifying intravascular catheters and no perfect method exists. Some debate the need for a test of correct location, as a lack of specificity may mean that a proportion of correctly located catheters are withdrawn and resited. This review outlines the incidence and risk factors associated with intravascular placement and aims to evaluate the detection methods that have been described, in an attempt to answer the question: “What is the optimal way of detecting intravascular placement of an epidural catheter?”
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Affiliation(s)
- D N Bell
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Tsui BCH, Sze CKC. An In Vitro Comparison of the Electrical Conducting Properties of Multiport Versus Single-Port Epidural Catheters for the Epidural Stimulation Test. Anesth Analg 2005; 101:1528-1530. [PMID: 16244025 DOI: 10.1213/01.ane.0000181006.36917.3e] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Effective conduction of electricity through a catheter is essential for the success of the epidural stimulation test. In this in vitro study we examined the electrical conductivity of single and multiport epidural catheters (with and without embedded metal elements) after being primed with normal saline. Seven different types of 19-gauge catheters (n = 5), either single-port or multiport catheters, with or without embedded metal elements, were studied. The proximal end of each epidural catheter was connected to the cathode of a nerve stimulator via an electrode adapter. The catheter, primed with normal saline, was placed at the bottom of a syringe filled with 5 different volumes of saline (1, 2, 3, 4 and 5 mL) and attached to an electrode adapter. The voltage of the peripheral nerve stimulator was measured using an oscilloscope. The electrical resistance between the proximal and distal end of the catheter was calculated using Ohm's Law. In catheters without metal elements the electrical resistances were too high to be measured. In catheters that had metal elements, the mean electrical resistances of the same catheter design (single-port or multiport) were similar. However, the electrical resistances of the multiport metal reinforced epidural catheters were significantly lower (P < 0.05) than the single-port metal coil reinforced epidural catheters. The volume of saline in the syringe had no impact on the measured electrical resistances. This study suggests that multiport metal reinforced epidural catheters have low electrical resistances and, thus, are a reasonable alternative to single-port catheters for transmitting sufficient current for performing the epidural stimulation test. On the other hand, epidural catheters without metal elements (single-port or multiport) are not suitable for performing the stimulation test.
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Affiliation(s)
- Ban C H Tsui
- *Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada; †Faculty of Engineering, University of Alberta, Edmonton, Alberta, Canada
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Gadalla F, Lee SHR, Choi KC, Fong J, Gomillion MC, Leighton BL. Injecting saline through the epidural needle decreases the iv epidural catheter placement rate during combined spinal-epidural labour analgesia. Can J Anaesth 2003; 50:382-5. [PMID: 12670816 DOI: 10.1007/bf03021036] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To determine if injecting 10 mL saline before epidural catheter threading (pre-cannulation epidural fluid injection) can decrease the incidence of iv epidural catheter placement during combined spinal-epidural (CSE) labour analgesia. METHODS One hundred healthy women requesting CSE labour analgesia with either fentanyl 20 microg or sufentanil 10 microg were prospectively randomized to receive either no epidural injection (dry group, n = 50) or epidural 10 mL saline injection (saline group, n = 50) before epidural catheter placement. A nylon multiport catheter was then threaded 3-5 cm into the epidural space and the needle was removed. We diagnosed iv catheter placement if blood was freely aspirated, if the mother became tachycardic after injection of epinephrine 15 microg, or if intracardiac air was heard (using ultrasound) after injection of air 1.5 mL. RESULTS Intravenous epidural catheter placement occurred in one saline and ten dry group patients (P < 0.01). No complications of excessive cephalad intrathecal opioid spread (i.e., difficulty swallowing, hypoxemia, or respiratory arrest) occurred. CONCLUSIONS Injecting 10 mL or saline through the epidural needle after intrathecal opioid injection and before threading the catheter significantly decreased accidental venous catheter placement without any apparent increase in complications from excessive cephalad intrathecal opioid spread.
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Affiliation(s)
- Farida Gadalla
- Department of Anesthesiology, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021, USA.
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Crews JC. New developments in epidural anesthesia and analgesia. ANESTHESIOLOGY CLINICS OF NORTH AMERICA 2000; 18:251-66. [PMID: 10935010 DOI: 10.1016/s0889-8537(05)70163-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Several recent advances in epidural anesthesia and analgesia have been reviewed. Perhaps the most exciting area of anticipated future developments relates to the continued development of novel analgesic agents and new epidural delivery systems. There appears to be some movement toward an increased use of intrathecal or peripheral neural blockade techniques for some clinical situations where epidural anesthesia and analgesia have been previously used; however, the ability to provide anesthesia and analgesia to relatively large areas of the body with a single injection or continuous catheter technique without the associated risks of dural puncture and intrathecal catheter placement will continue to assure epidural anesthesia and analgesia techniques a prominent role in anesthesia and pain management.
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Affiliation(s)
- J C Crews
- Pain Control Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
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Affiliation(s)
- D J Birnbach
- Department of Anesthesiology, St. Luke's Roosevelt Hospital Center, Columbia University, New York, NY 10019, USA
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Jaime F, Mandell GL, Vallejo MC, Ramanathan S. Uniport soft-tip, open-ended catheters versus multiport firm-tipped close-ended catheters for epidural labor analgesia: a quality assurance study. J Clin Anesth 2000; 12:89-93. [PMID: 10818320 DOI: 10.1016/s0952-8180(00)00116-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To compare a multiport, firm-tipped, close-ended, epidural catheter (Portex catheter) with a uniport, open-ended, soft-tipped, wire-reinforced catheter (Arrow catheter) in obstetric patients. STUDY DESIGN Prospective data collection for intradepartmental quality assurance. SETTING Obstetric unit in a tertiary care maternity hospital. PATIENTS 2612 patients requesting labor analgesia. INTERVENTIONS The Arrow catheter was used in 1,352 women and the Portex catheter in 1,260 women. MEASUREMENTS AND MAIN RESULTS The incidence of unsatisfactory block were 3.3% and 4.4% with the Arrow and Portex catheters, respectively (p = 0.2). The catheter perforated the dura matter in 0.4% of cases with both catheters. The incidence of epidural venipuncture was 1.1% with the Arrow catheter and 5.7% with the Portex catheter (p = 0.0001). Paresthesias occurred in 6% of cases with the Arrow catheter and 11. 2 % of cases with the Portex catheter (p = 0.0001). Epidural catheter reinsertion was required in fewer patients in the Arrow group than in the Portex group (4.8% vs. 7.1%; p = 0.01). CONCLUSIONS In obstetric patients, the softer uniport Arrow catheter produces paresthesias and venipunctures less frequently than the firm multiport Portex catheter.
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Affiliation(s)
- F Jaime
- Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213-3180, USA
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McAtamney D, O'Hare C, Fee JP. An in vitro evaluation of flow from multihole epidural catheters during continuous infusion with four different infusion pumps. Anaesthesia 1999; 54:664-9. [PMID: 10417459 DOI: 10.1046/j.1365-2044.1999.00892.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We have observed in vitro the distribution of flow from 10 identical multihole epidural catheters during continuous infusion with four different infusion pumps. The pumps chosen were the B Braun Perfusor Secura FT syringe driver and three volumetric infusion pumps utilising different pumping mechanisms (Dekra 3000 BL, Graseby 500 and CADD-Prizm). These pumps infused 0.9% saline through each catheter at 5 ml.h-1, 15 ml.h-1, 50 ml.h-1 and 99 ml.h-1 for 3 min. The number of holes through which flow occurred and the catheter hole where flow predominated during each test were recorded. The pressure waveform generated during each infusion was displayed and the peak pressure recorded. In 38 of the 160 tests (24%) the largest proportion of flow was seen at the hole closest to the catheter tip. The CADD pump generated multihole flow during significantly more tests (p < 0.0001) than the other pumps and produced significantly higher driving pressures (p < 0.001) at all infusion rates compared with the Graseby and Perfusor pumps. The CADD was the only pump to produce flow from all three holes of the catheter at 5 ml.h-1.
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Affiliation(s)
- D McAtamney
- Department of Anaesthetics, Queen's University of Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
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