Accidental venous and dural puncture during epidural analgesia in obese parturients (BMI > 40 kg/m 2): three different body positions during insertion

Abstract

Study Objective To assess the frequency of blood vessel punctures in morbidly obese parturients [body mass index (BMI) > 40 kg/m 2] during epidural catheterization, in three different body positions. Design Prospective, randomized study. Setting Delivery room of a university-affiliated hospital. Patients 347 obese parturients (BMI > 40 kg/m 2) undergoing continuous epidural analgesia during labor. Interventions Patients were randomized to undergo epidural catheterization in the sitting, lateral recumbent horizontal, or lateral recumbent head-down positions. Measurements and Main Results A lower frequency of epidural venous cannulation was noted when this procedure was performed in the lateral recumbent head-down position (4.8%) than in the lateral recumbent horizontal (11.6%) or sitting position (18.3%) ( P = 0.001). Frequency of accidental subarachnoid puncture did not differ significantly (2.5%, 2.6%, and 3.7%), respectively. Conclusion Adoption of the lateral recumbent head-down position for the performance of lumbar epidural blockade in labor at term reduces the frequency of lumbar epidural venous puncture in obese parturients (BMI > 40 kg/m 2).