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18.10.2018 | Originalien

Epidural needle insertion

A large registry analysis

verfasst von: Dr. med. H. Bomberg, MD, N. Paquet, A. Huth, Dr. Prof. S. Wagenpfeil, Dr. Prof. P. Kessler, Dr. Prof. H. Wulf, T. Wiesmann, Dr. Prof. T. Standl, Dr. Prof. A. Gottschalk, Dr. J. Döffert, Dr. Prof. W. Hering, Dr. PD. J. Birnbaum, Dr. B. Kutter, Dr. J. Winckelmann, Dr. S. Liebl-Biereige, Dr. Prof. W. Meissner, Dr. O. Vicent, Dr. Prof. T. Koch, Dr. Prof. H. Bürkle, Dr. Prof. D. I. Sessler, Dr. A. Raddatz, Dr. Prof. T. Volk

Erschienen in: Die Anaesthesiologie | Ausgabe 12/2018

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Abstract

Background

Dural puncture, paraesthesia and vascular puncture are the most common complications of epidural catheter insertion. Their association with variation in midline needle insertion depth is unknown.

Objective

This study evaluated the risk of dural and vascular punctures and the unwanted events paraesthesia and multiple skin punctures related to midline needle insertion depth.

Material and methods

A total of 14,503 epidural catheter insertions including lumbar (L1–L5; n = 5367), low thoracic (T7–T12, n = 8234) and upper thoracic (T1–T6, n = 902) insertions, were extracted from the German Network for Regional Anaesthesia registry between 2007 and 2015. The primary outcomes were compared with logistic regression and adjusted (adj) for confounders to determine the risk of complications/events. Results are presented as odds ratios (OR, [95% confidence interval]).

Main results

Midline insertion depth depended on body mass index, sex, and spinal level. After adjusting for confounders increased puncture depth (cm) remained an independent risk factor for vascular puncture (adjOR 1.27 [1.09–1.47], p = 0.002) and multiple skin punctures (adjOR 1.25 [1.21–1.29], p < 0.001). In contrast, dural punctures occurred at significantly shallower depths (adjOR 0.73 [0.60–0.89], p = 0.002). Paraesthesia was unrelated to insertion depth. Body mass index and sex had no influence on paraesthesia, dural and vascular punctures. Thoracic epidural insertion was associated with a lower risk of vascular puncture than at lumbar sites (adjOR 0.39 [0.18–0.84], p = 0.02).

Conclusion

Variation in midline insertion depth is an independent risk factor for epidural complications; however, variability precludes use of depth as a reliable guide to insertion in individual patients.

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Titel: Epidural needle insertion
A large registry analysis
verfasst von: Dr. med. H. Bomberg, MD
N. Paquet
A. Huth
Dr. Prof. S. Wagenpfeil
Dr. Prof. P. Kessler
Dr. Prof. H. Wulf
T. Wiesmann
Dr. Prof. T. Standl
Dr. Prof. A. Gottschalk
Dr. J. Döffert
Dr. Prof. W. Hering
Dr. PD. J. Birnbaum
Dr. B. Kutter
Dr. J. Winckelmann
Dr. S. Liebl-Biereige
Dr. Prof. W. Meissner
Dr. O. Vicent
Dr. Prof. T. Koch
Dr. Prof. H. Bürkle
Dr. Prof. D. I. Sessler
Dr. A. Raddatz
Dr. Prof. T. Volk
Publikationsdatum: 18.10.2018
Verlag: Springer Medizin
Erschienen in: Die Anaesthesiologie / Ausgabe 12/2018
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI: https://doi.org/10.1007/s00101-018-0499-1

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Epidural needle insertion

A large registry analysis