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The Inability to Obtain CSF via The Spinal Needle During CSE Placement Predicts Epidural Catheter Failure: A Retrospective Chart Review
Abstract Number: F2A-1
Abstract Type: Original Research
Introduction: Pain relief strategies during labor continue to be an area for investigation. Two well described neuraxial techniques are the epidural and combined spinal epidural (CSE), both utilizing a lumbar epidural catheter. No technique demonstrates superiority . This retrospective study aims to clarify whether obtaining CSF through the spinal needle during CSE catheter placement reduces the risk of immediate epidural catheter failure.
Methods: We performed a search utilizing the Obstetrics QI Database for patients from June 7th, 2016 – January 9th, 2018. Our primary endpoint was rates of immediate catheter failure when at least one loss of resistance (LOR) attempt failed to yield CSF through the spinal needle during CSE placement. Catheter failure was defined by occurrence of the following within 3 hours: replacement of neuraxial, disparity of >3 sensory dermatomes, no block, or unilateral block.
Results: Of our total patient population of 2188, 1598 met initial inclusion criteria. Patients were divided into three categories: 1) Control Group (n=1457) - CSF obtained on 1st LOR attempt, 2) Group 1 (n=82) - no CSF on initial LOR, but obtained during procedure, Group 2 (n= 59) -no CSF on initial LOR, and no CSF obtained prior to threading catheter. Failure rates were 5.2% for Control Group, 10.9% for Group 1 and 40.6% for Group 2. Chi squared statistical analysis demonstrated a significant difference between Group 1 and Group 2 (P <.001%) in catheter failure. Further, providers with obstetric anesthesiology fellowship training were more likely to obtain CSF with troubleshooting techniques including redirection or attempts at another level after failure to obtain CSF with initial LOR than providers without specialty training (51.8 vs 18.4 %, P <.001%).
Discussion: Our study suggests that obtaining CSF via a spinal needle during attempted CSE technique may result in lower immediate failure rates when compared to failing to obtain CSF prior to threading a catheter. Providers with obstetric anesthesiology fellowship training were more likely to utilize techniques to obtain CSF during attempted CSE placement compared to providers without additional training resulting in decreased catheter failure rates. The limitations of our study include a small number of identified patients and utilization of retrospective data.
1.Thomas, J., et al. The JASA, 103(5), 1046-1051.