Confirmation of epidural catheter placement using nerve stimulation

Purpose: To examine the reliability of low current electrical epidural stimulation to confirm epidural catheter placement. Methods: Forty patients with epidural catheters (19G Arrow Flextip plus) already in place for post-operative pain management were studied. An adapter (Arrow-Johans ECG Adapter) was attached to the connector of the epidural catheter. The epidural catheter and adapter were filled with normal saline. The cathode lead of the nerve stimulator was attached to the metal hub of the adapter. Catheter placement was judged to be correct or incorrect, depending on the presence or absence of truncal or limb movement to 1 Hz stimulation (1-10 mA). A standard test dose (3 ml lidocaine 1.5% with 1:200,000 epinephrine) was then injected. The efficacy of the epidural morphine was assessed independently. Results: The sensitivity and specificity of the test was 100% and 91.6% compared with the standard test dose. The positive and negative predictive value was 96% and 100%. In predicting the clinical effect of epidural morphine, the sensitivity and specificity was 96.1% and 76.99%. The positive and negative predictive value was 89% and 90%. The correlation of unilateral or bilateral motor response from the test and sensory response from the lidocaine test with sensitivity and specificity was 91.6% and 53.0%. The predictive value for unilateral response from was 61% and for bilateral was 88%. Conclusion: This study establishes this test as a simple, objective and reliable technique for confirmation of epidural catheter placement.