Epidural catheters for obstetrics. Terminal hole or lateral eyes?

BACKGROUND AND OBJECTIVES

Controversy exists over the choice of the ideal epidural catheter for obstetric use, particularly whether the catheter should have a single terminal hole or three lateral eyes.

METHODS

A randomized single-blind study of 200 obstetric patients undergoing epidural block for analgesia in labor or for cesarean delivery was undertaken, using either a catheter with a terminal hole or three lateral eyes. The extent and quality of the block was recorded, as well as the presence of any complications.

RESULTS

The study was abandoned after 102 patients had been assessed, as the incidence of unsatisfactory blocks with terminal eye catheters was found to be unacceptably high (32%), when compared with the lateral eye catheters (12%) (P < .05). Four of the terminal eye catheters (8%) had to be resited compared with one of the lateral eye catheters (2%). One case of intravascular injection (2%) occurred through a terminal eye catheter, despite repeated negative attempts at aspiration.

CONCLUSIONS

The use of terminal eye epidural catheters in our obstetric patients has led to an unacceptably high incidence of both unsatisfactory blocks and catheter replacement. Lateral eye catheters produced better results in our circumstances.