Superiority of multi-orifice over single-orifice epidural catheters for labor analgesia and cesarean delivery.

STUDY OBJECTIVE

To investigate whether a change from a single-orifice to multi-orifice catheter could reduce the incidence of inadequate epidural blocks requiring replacement of the epidural catheter in obstetric patients.

STUDY DESIGN

Prospective before-after cohort study.

SETTING

Obstetric unit at a university hospital.

PATIENTS

872 patients requesting epidural analgesia for vaginal delivery or cesarean section.

INTERVENTIONS

Patients received epidural analgesia via single-orifice (n = 433) or multi-orifice (n = 439) epidural catheters, depending on the month of the trial.

MEASUREMENTS AND MAIN RESULTS

Patient characteristics, obstetric procedure, anesthesiologist characteristics, and details of epidural placement did not differ significantly between the groups. The overall replacement rate was 14.3% in the single-orifice group versus 9.3% in the multi-orifice group (p = 0.032). There were no difference in the frequency of replacement for subarachnoid placement or migration, immediate intravascular placement, vascular migration, or absence of any block. Significantly fewer catheters were replaced in the multi-orifice group for inadequate analgesia, defined as unblocked segments or unilateral block (6.4% vs. 2.8%, p = 0.018). Paresthesias were less common in the multi-orifice group (22.4% vs. 31.5%, p = 0.003). There were no unrecognized subarachnoid or vascular catheter placements in either group.

CONCLUSIONS

The multi-orifice design offers significant advantages over the single-orifice type for obstetricepidural analgesia.