LESSONS LEARNED FROM THE CANADIAN PDPH TRIAL: SUCCESSES AND PITFALLS OF USING 19g Tuohy Needles/23g CATHETERS FOR LABOR ANALGESIA
Abstract Number: 22
Abstract Type: Original Research
While smaller epidural needles have potential to reduce postdural puncture headache(PDPH), difficulties associated with their use require further investigation. We report preliminary findings from a large multi-centered randomized trail which examined the feasibility and impact of using small epidural needles for labor analgesia.
Women were randomized to receive either a 19g Tuohy-type needle/23g catheter versus a 17/18g Tuohy-type needle. Patient controlled epidural analgesia (PCEA) was used. The primary outcome was the incidence of PDPH using a formal study definition. Anesthesiologists recorded difficulties/complications with epidural placement and analgesia initiation/maintenance. Blinded assessors collected data on days 1, 3 and 14. A blinded per protocol feasibility/safety analysis was conducted at 25% recruitment.
Feasibility/safety were examined in 814 women. Demographics were comparable between groups. Recognized/suspected dural puncture occurred during placement in 1.2%(5/406) of Group 1 vs. 1.5%(6/407)Group 2. Successful (<30minutes) analgesia occurred in 95% of Group 1 vs. 97.5% of Group 2. Women rated overall analgesia similarly (Group 1: >Good =89.6% vs. Group 2: > Good = 94.1%). Group 1 had more replaced catheters 7.2 %( 29/404) vs. 3.2 %( 13/403) and somewhat less provider satisfaction with catheters/PCEA pumps during maintenance. No serious adverse events occurred.
Study findings suggest that it is possible to use small gauge epidural needles for labor analgesia. Study recruitment has finished. Full findings will be available Spring 2010.