During epidural anesthesia, the catheter tip occasionally deviates from the epidural space into the intervertebral foramen, resulting in inadequate anesthesia.
During postoperative plain radiography, iohexol was injected via the epidural catheter to determine its position and to observe the spread of the material. After exclusion of seven patients with catheters that migrated into the subcutaneous area and 25 patients with no evidence of the contrast medium, 415 patients were evaluated. We retrospectively compared patients to determine whether the incidence of deviation into the intervertebral foramen differed between four types of epidural catheters. We also investigated the load applied to the catheter tip using a Shimadzu Autograph AG-X-500 N-111 universal testing machine.
Deviation of the epidural catheter into the intervertebral foramen was observed in eight and 33 patients in the Hakko and Perifix Soft tip catheter groups, respectively. The incidence of deviation was higher in the Perifix Soft tip catheter group, and lower in the FlexTip Plus and Perifix FX catheter groups. A rapid increase was observed in the force exerted on the tips of the Hakko and Perifix Soft tip catheters, while the force transmitted to the tips of the FlexTip Plus and Perifix FX catheters gradually increased and then reached a plateau at a low level.
The incidence of deviation was significantly lower with spiral-type catheters than with other types of catheters. This might be attributable to the gradual transmission of a lower level of force to the tip in spiral-type catheters.
Ito T, Kawabata M, Suda T, Koumizu K, Kaneko E, Tachihara H. The malposition of catheters in the epidural space. Pain Clinic. 1989;10:106–12.
Hehre FW, Sayig JM, Lowman RM. Etiologic aspects of failure of continuous lumbar peridural anesthesia. Anesth Anal. 1960;39:511–7. CrossRef
Kawaguchi T, Inoue S, Fukunaga A. Clinical analysis of failures in continuous lumbar epidural anesthesia. Masui. 1966;15:1130–6. PubMed
Terasako K. Reduced risk of intravascular catheterization with a soft epidural catheter. Acta Anaesthesiol Scand. 1999;43:240. PubMed
Juneja M, Kargas G, Miller D. Comparison of epidural catheters induced paresthesia in parturients. Reg Anesth. 1995;20:152.
Uchino T, Miura M, Noguchi T, Shimada K. A clinico-anatomical study of epidural catheter displacement. Jpn Res Soc Clin Anat. 2012;12:60–1.
Sa’nchez R, Acuna L, Rocha F. An analysis of the radiological visualization of the catheters placed in the epidural space. Br J Anaesth. 1967;39:485–9. CrossRef
Andoh K, Shima T, Hoshi K, Hashimoto Y. An X-ray study of catheters abnormally placed in the epidural space. Masui. 1991;40:1598–602. PubMed
Kobayashi N. A comparison of 7 types of epidural catheters. Masui. 1990;39:335–42. PubMed
Oku S, Nishimoto N, Danjo S. Epidural catheter accidentally inserted along the left 11th intercostal nerve. Masui. 1977;26:190–3. PubMed
Foldes FF, Colavincenzo JW, Birch JH. Epidural anesthesia: a reappraisal. Curr Res Anesth Analg. 1956;35:33–47. PubMed
Kawagoe I, Tajima K, Kanai M, Mitsuhata H. The direction and the position of epidural catheter tips inserted 5 or 7 cm cephalad did not differ. Masui. 2010;59:1171–7. PubMed
Saitoh K, Kawakami T, Hotta K, Inoue S, Horiguchi Y, Fukuda H, Hirabayashi Y, Mitsuhata H, Shimizu R. A radiological analysis of the position of lumbar epidural catheters: a comparison between median and paramedian approach. Masui. 1995;44:70–2. PubMed
Beck H. The effect of the Tuohy cannula on the positioning of an epidural catheter. A radiologic analysis of the location of 175 peridural catheters. Reg Anaesth. 1990;13:42–5. PubMed
Shima T, Haga S, Mikami M, Ban M, Matsukawa S, Kato M. An X–ray study of the catheters misplaced in the subdural space. J Clin Anesth Jpn. 2000;24:1113–6.
Nonaka A, Nakano S, Kumazawa T. Repeated inadvertent subdural catheterization: a case report. Masui. 1990;39:778–81. PubMed
Okuyama A, Makise N, Kemmotsu O. Accidental subdural catheterization discovered after postoperative respiratory depression. Masui. 1993;42:427–30. PubMed
Shibata K, Murakami S, Ikegaki S, Yagi Y. Unusual clinical course of accidental subdural block. Masui. 1988;37:365–9. PubMed
Collier CB. Accidental subdural block: four more cases and a radiographic review. Anaesth Intensive Care. 1992;20:215–25. PubMed
Motamed C, Farhat F, Remerand F, Stephanazzi J, Laplanche A, Jayr C. An analysis of postoperative epidural analgesia failure by computed tomography epidurography. Anesth Anal. 2006;103:1026–32. CrossRef
- Lateral deviation of four types of epidural catheters from the lumbar epidural space into the intervertebral foramen
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