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Epidural Catheter Movement in Parturients with Class 3 Obesity
Abstract Number: T2I-505
Abstract Type: Original Research
Background: Epidural catheter movement (ECM) with changes in parturient positioning was first described in 1997 by Hamilton et al., who conducted a prospective study evaluating ECM with patient movement. 1 They found that with increasing BMI, epidural catheters (EC) moved a statistically significant amount with patient repositioning. While their study included obese women, it did not look specifically at parturients with Class 3 obesity (C3O), defined by the CDC as BMI≥40.2 OB anesthesiologists today care for double the number of women with C3O than they did in 1997.3 The amount of ECM is important to know so that precise adjustments can be made for optimal anesthetic effects and to prevent EC failure. We hypothesized that we would replicate the Hamilton study’s findings of ECM in obese women, finding greater ECM in our C3O parturients.
Methods: Following IRB approval, we performed a retrospective chart review of all labor epidurals/CSEs placed in 2017 and 2018 at our institution. We reviewed neuraxial procedure notes of all women with a BMI≥40 and gathered the following data: distance to epidural space, distance of initial EC placement, and distance of final EC position after patient repositioning. ECM was defined as the difference between initial and final EC positions. A scatter plot was created to evaluate the correlation of BMI and ECM. Data were analyzed using OriginPro 2019; OriginLab; Northampton, MA.
Results: Data were collected on 788 women identified as having a BMI≥40. Median BMI was 43.6, and the highest reported BMI was 79.2. ECM ranged from 0-5cm (median 2cm). Pearson’s correlation coefficient for BMI and ECM was 0.2225 with an R2 value of 0.0496 (Figure 1).
Conclusion: Our data reveal a weakly positive correlation between BMI≥40 and ECM in parturients receiving epidural labor analgesia. We believe it is likely that this retrospective methodology underestimates the true degree of ECM. First, patient repositioning was not specifically documented in the procedure note. Our standard repositioning places the patient laterally, but it is not known how often this occurred. Secondly, precise EC measurements were not made. We have initiated a prospective study to address these weaknesses but currently do not have enough data to report.
1. Hamilton CL, et al. Anesthesiology 1997; 86(778-84).
2. CDC..https://www.cbc.gov/obesity. Accessed 11.13.18.
3. CDC. https://www.cdc.gov/nchs. Accessed 1.19.19.