By L.J. Epstein MD, E. Frost MD

Department of Anesthesia,
The New York Mecial College,
Valhalla, New York 10595
Epidural Anesthesia, Apidural Cetheterization

INTRODUCTION: Malposition of the catheter is a problem frequently encountered during administration of an epidural anesthetic. Correction of this situation involves removal of both needle and catheter and replacement of same. Advances in needle design have been aimed at allowing safer manipulation of the catheter with the needle tip still in the epidural space. In our study, we evaluated a new plastic epidural introducer for the placemetn of epidural catheters.

METHODS: After obtaining consent, five healthy parturients scheduled for elective cesarean section or requesting labor analgesia were studied. Patients were placed in either the lateral or sitting position. The skin around the lubar spine was prepped with betadine solution and strict aseptic technique was employed. The skin overlying L3-L4 interspace was anesthetized with 1% lidocaine. The epidural space was identified using a loss of resistance (to saline) with the Spinal Cord Access System (SCA ^tm) (Custom Medical Concepts Incorporated, Chelmsford, Massachusetts). This system employs a plastic catheter over a needle equal to a 17 ga needle. After the epidural space is identified, the plastic catheter is advanced over the needle and into the epidural space. An initial test dose of 3cc of 1.5% lidocaine with epinephrine 1:200,000 was injected followed by 8cc of 0.25% bupivicaine (for labor analgesia) or 20 cc of 1.5% lidocaine with 1:400,000 epinephrine (in incremental doses). A 20 ga nylon catheter (without stylet) was then passed through the introducer and into the epidural space. The introducer was removed and the epidural catheter tested prior to use.

Results: All 5 patients tolerated the procedure well. There were no problems identifying the epidural space with the SCA ^tm system. The introducer was placed without technical difficulty. It was possible to aspirate and inject freeely via the introducer. in all patients the catheter was positioned easily via the introducer.