Epidural catheter fixation: subcutaneous tunnelling with a loop to prevent displacement.

A method of fixing the epidural catheter by subcutaneous tunnelling and looping was devised. A prospective, randomised, double-blind, clinical trial was conducted in 68 adult patients, where postoperative pain relief was planned by thoracic epidural analgesia. In the tunnelled group (n = 34), the epidural catheter was fixed with a subcutaneous tunnel and loop, whereas in controls (n = 34), a simple loop of epidural catheter was left over the skin without tunnelling. An adhesive dressing was used to secure the epidural catheter. We observed that catheter dislodgement occurred in only one patient in the tunnelled group compared to seven control patients (21%). Despite local inflammation of the skin around the tunnel in nine patients (27%), no catheter infection (positive culture tip) was found in patients with subcutaneous tunnelling for the extended period of 4-5 days. The method described allows the catheter to lie flat on the skin and outward traction of the catheter during movement of patients is dampened by the interposed loop which protects it against dislodgement. At the time of removal, both ends of the catheter can be removed under direct vision. In conclusion, we recommend this fixation method in cases where epidural analgesia is to be used for postoperative pain relief.