Method for assessing the degree of external dislocation of an epidural catheter when carrying out a combined two-level spinal-epidural anesthesia

Abstract

AIM: To present the practical importance of the proposed method for assessing the degree of external dislocation of an epidural catheter in the daily work of an anesthesiologist-resuscitator, with which a doctor can assess the risk of deterioration in the quality of anesthesia and, using the developed algorithm, take measures to prevent epidural catheter loss and epidural analgesia termination.
 MATERIALS AND METHODS: This study selected 62 patients who underwent the two-level combined spinal-epidural anesthesia with fixation of an epidural catheter in the subcutaneous canal during operations of lower limbs fractures. All patients underwent postoperative epidural analgesia.
 A method for assessing the degree of external dislocation of an epidural catheter and an algorithm of actions when detecting a dislocation of an epidural catheter has been developed. The degree of dislocation of the epidural catheter was assessed when changing the fixing aseptic sticker and additional measures were taken to enhance the fixation of the epidural catheter when a pronounced dislocation was detected.
 RESULTS: The use of the method for assessing the degree of external dislocation of the epidural catheter and the implementation of the algorithm of actions upon the detection of the epidural catheter dislocation made the conduction of high-quality postoperative anesthesia in 61 patients possible. In 10 patients, when a pronounced dislocation was detected and the threat of the epidural catheter was loss (dislocation of 45 degrees, 1530 mm), special fixation devices Epi-Fix were used for additional fixation, which made the continuation of the epidural analgesia possible.
 In the first case (1.61%), wherein epidural analgesia had to be discontinued after 48 h, the 6th degree of dislocation of the epidural catheter (33 mm) was established and the catheter was removed. Postoperative pain relief was continued with the introduction of non-steroidal anti-inflammatory drugs.
 CONCLUSIONS: Using the method for assessing the degree of external dislocation of an epidural catheter in the daily practice of an anesthesiologist-resuscitator assessed the risk of deterioration and termination of epidural anesthesia possible, thus prevention measures were performed.