PREDISTENTION OF THE EPIDURAL SPACE WITH NORMAL SALINE BEFORE CATHETER INSERTION REDUCES THE INCIDENCE OF INADVERTENT INTRAVASCULAR EPIDURAL CATHETER PLACEMENT

BACKGROUND Accidental cannulation of an epidural vein is a common complication associated with continuous epidural anaesthesia or analgesia. Based on available literature, we studied and tested the hypothesis that predistention of the epidural space with saline before epidural catheterisation would ease catheter insertion and decrease the incidence of this complication. MATERIALS AND METHODS Two hundred women for elective caesarean section were randomly assigned to receive an epidural with loss of resistance technique with 2 mL (non-distention group) or 5 mL normal saline (distention group). In the distention group, the syringe plunger was held close for 20 seconds before epidural catheter insertion. Then in both groups, a test dose of 3 mL of 2% lidocaine with adrenaline was injected through the epidural catheter. RESULTS There were fewer accidental intravascular catheter placements (2% vs 15%, P value 0.001) in the distention group compared to the non-distention group. CONCLUSION Distention of the epidural space with 5 mL normal saline before epidural catheter insertion decreased the incidence of accidental venous cannulation (Anesth Analg 2007; 105: 460-4) and can make unintentional intravascular catheter placement an avoidable complication.