Injection of fluid through into the epidural space prior to epidural catheter insertion: a meta-analysis
Abstract Number: 159
Abstract Type: Meta Analysis/Review of the Li
Background: Fluid is commonly injected into the epidural space following identification of the epidural space as some clinicians believe that expansion of the epidural space may result in fewer complications (e.g., accidental vascular catheter insertion, paresthesias) or greater ease in epidural catheter insertion. However, the overall efficacy of fluid injection into the epidural space following identification of the epidural space is unclear. We have performed a meta-analysis to further examine this issue.
Methods: Systematic literature searches of PubMed and EMBASE databases were conducted using terms related to local anesthetic, saline, and epidural. Only randomized controlled trials comparing injection of fluid (i.e., saline or local anesthetic) to no injection into the epidural space after identification of the epidural space were included for analysis. Meta-analysis was performed using the Review Manager 4.2.10.
Results: 5 articles met all inclusion criteria. There were a total of 528 subjects for the fluid group and 420 for the no fluid group. We found fluid injection into the epidural space (vs. no fluid injection) was associated with a reduced risk of venous cannulation [(RR) = 0.54, 95% (CI): 0.35, 0.84; p = 0.0006] but there was no difference between the groups with regard to transient paresthesias [RR = 0.84, 95%CI: 0.40, 1.74; p = 0.63] or ease of epidural catheter placement [RR = 0.97, 95%CI: 0.90, 1.05; p = 0.50].
Conclusions: Injection of fluid into the epidural space following identification of the epidural space may result in a lower risk of venous cannulation but without a decrease in transient paresthesias or improved ease of catheter placement. Further examination with larger RCT is warranted as the overall number of subjects is relatively small.
Evron S et al. Predistention of the epidural space before catheter insertion reduces the incidence of intravascular epidural catheter insertion. Anesth Anal. 2007 Aug;105(2):460-4.
Cesur M et al. Administration of local anesthetic through the epidural needle before catheter insertion improves the quality of anesthesia and reduces catheter-related complications. Anesth Analg. 2005 Nov;101(5):1501-5.
Gadalla F et al. Injecting saline through the epidural needle decreases the iv epidural catheter placement rate during combined spinal-epidural labour analgesia. Can J Anaesth 2003;50:382-5.
Tseng CH et al. Prior epidural injection of 10 ml normal saline reduces the incidence of inadvertant venous puncture in epidural catheterization. Acta Anaes Sin 1995;33:27-30.
Geernaert K et al. Does epidural injection of physiological saline facilitate the advancement of catheters? Eur J Anaes 1993;10:349-51.
Scott DA, Beilby DS. Epidural catheter insertion: the the effect of saline prior to threading in non-obstetric patients. Anaesth Inten Care 1993;21:284-7.
Rolbin SH et al. Fluid through the epidural needle does not reduce complications of epidural catheter insertion.Can J