///2010 Abstract Details
2010 Abstract Details2019-08-03T15:49:10-05:00

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

Pamela Angle MD, MSc1 ; Ron George MD2; Joanne Douglas MD3; Indu Singh MD4; Alexander Kiss PhD5; Canadian PDPH Collaborative PDPH6

Introduction:

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.

Methods:

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.

Results:

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.

Discussion:

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.

SOAP 2010