Epidural Catheter Insertion Research Articles

Relationship between epidural catheter migration beneath the skin and subcutaneous fat thickness assessed using postoperative CT imaging: a retrospective cross-sectional study.

The causes of epidural catheter migration beneath the skin have not been previously investigated. We hypothesized that greater subcutaneous fat thickness might be associated with increased catheter migration beneath the skin. We conducted a retrospective cross-sectional study of patients who had undergone combined general and epidural anesthesia, selecting individuals who received thoracic and abdominal CT scans within the first 5 postoperative days. Needle depth was defined as the distance from the needle tip to the skin surface when the anesthesiologist determined that the needle tip had reached the epidural space. We measured the length of the epidural catheter from the skin surface to the epidural space (catheter length), and subcutaneous fat thickness (fat thickness) using CT imaging. Migration distance was calculated by subtracting needle depth from catheter length. We analyzed 127 patients (72 males), all undergoing epidural catheter insertion in the left lateral decubitus position via a paramedian approach. The median age of the patients was 71years. Epidural catheters were postoperatively found to substantially curve beneath the skin. Regression analysis revealed no significant influence of fat thickness on catheter length (regression coefficient 0.10, 95% confidence interval [CI]: - 0.17, 0.38). However, it indicated a positive correlation between fat thickness and needle depth (regression coefficient 0.50, 95% CI: 0.30, 0.70), and a negative correlation between fat thickness and migration distance (regression coefficient - 0.40, 95% CI: - 0.65, - 0.14). We found a negative correlation between epidural catheter migration beneath the skin and subcutaneous fat thickness. Anesthesiologists should be aware of the possibility of substantial subcutaneous curving of the catheter, especially in patients with scant subcutaneous fat.

Comparison of Ultrasound Guided Quadratus Lamborum Plane Block versus Intraperitoneal and Port Sites Bupivacaine Infiltration in Post Operative Analgesia after Laparoscopic Cholecystectomy

Abstract Background Poorly controlled acute pain after abdominal surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay and an increased likelihood of chronic pain. Aim of the Work The aim of this study is to assess the postoperative analgesic efficacy of quadratus lamborum plain block compared to intraperitoneal and periportal infiltration with bupivacaine after laparoscopic cholecystectomy regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. Patients and Methods The study was conducted on 70 randomly chosen patients aged 20 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled for elective laparoscopic cholecystectomy in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 35 patients each: QL block Group, intraperitoneal and periportal infiltration Group: Results Patients receiving QL block had significantly lower pain scores at rest for 6 hrs and decrease total need of analgesic in first 24 h post operative compared with patients who received Intraperitoneal and port sites infiltration. Conclusion Quadratus Lumborum block was effective in reducing postoperative pain scores for 6 hours and lower total 24 hrs postoperative opioid and analgesic consumption after laparoscopic cholecystectomy under general anesthesia, compared to intraperitoneal and port sites infiltration. This technique can be a promising mode of postoperative analgesia where epidural catheter insertion is contraindicated.

Impact of Epidural Catheter-Incision Congruency on Postoperative Analgesia after Major Abdominal Surgery: An Observational Study in a Teaching Hospital.

To determine the frequency of appropriate epidural catheter-incision congruency in adult patients undergoing major abdominal surgeries, as well as the frequency of ineffective postoperative analgesia with continuous epidural infusion, side effects, and complications of epidural insertion and epidural catheter infusion. Observational study. Place and Duration of the Study: Department of Anaesthesiology, The Aga Khan University Hospital, Karachi, Pakistan, from September to November 2022. All adult patients who underwent elective major abdominal surgery under general anaesthesia with epidural analgesia were included in this study. Data were collected by chart review of the patients enrolled in Acute Pain Service for the study period. Intraoperative anaesthesia form, epidural infusion form and all records of acute pain service for the postoperative period were reviewed and recorded. One hundred and eighty-two patients were included in this study. The epidural catheter was inserted congruent to the surgical incision i.e. T10-T11 level or above in 43 (23.6%) patients only. In the postoperative period, overall effective epidural analgesia was observed in 79 (43.4%) of the patients. Motor block in lower limbs was observed in 66 (36.26%) of patients in the immediate postoperative period. The present study shows appropriate epidural catheter-incision congruency in only 23.6% of the patients. This could be one of the common reasons for ineffective postoperative pain relief via epidural analgesia in 56.6% of patients. Epidural catheter insertion site, Major abdominal surgeries, Postoperative analgesia.

Predicting clinical entry point for thoracic epidural catheter insertion during paramedian approach: A prospective observational study.

Thoracic epidural insertion has high failure rates in the mid-thoracic region due to steep angulation of oblique bending of spinous processes. The preferred skin puncture point for epidural needle insertion in the paramedian sagittal plane with respect to the superior/inferior tip of spinous process or inter-spinous cleft in the mid-thoracic region (T5-8) is not standard. The primary objective of this prospective observational study was to find the skin puncture point which had the best success rate for a successful epidural catheterization. Secondary objectives were to study the number of attempts and passes required to locate epidural space, incidence of failed epidural, and its relationship with patient characteristics and demographics. After informed consent, 155 patients planned for general anesthesia with epidural analgesia in the mid-thoracic region were included in the trial. Patient demographics, the details of epidural attempts with respect to anatomical landmarks, distance from the midline, and number of passes in each attempt were noted. Epidural catheterization was considered successful after demonstrating dermatomal band of sensory blockade. The success rate at different skin puncture sites was not statistically significant (P = 0.58). We found a failure rate of 12.9%. Failed epidural catheterization was significantly high in the age group >56 years (n = 62 and P = 0.007). In our study, none of the skin puncture points had a significant association with successful epidural insertion in mid-thoracic segments using a para-median approach.

Effects of Differences in Epidural Needle Entry Point and Angle of Rotation of Needle Hub on the Onset and Duration of Sensory Blockade in Lower Limb Orthopaedic Surgeries: A Randomised Controlled Trial

Introduction: Epidural anaesthesia is a boon for providing prolonged analgesia for postoperative pain relief. The influence of epidural needle insertion on the onset of the block, which has not been studied previously, is significant. Aim: To analyse the effect of epidural needle entry and rotation of the needle on the onset and duration of the block. Materials and Methods: This double-blinded randomised controlled trial was conducted at the Department of Anaesthesiology, SRM Institute of Science and Technology, Chennai, Tamil Nadu, India from March 2020 to August 2021 on 70 patients undergoing leg and ankle surgeries. They were randomised into Group-ML (midline approach) and Group-PM (paramedian approach). In Group-ML, midline epidural needle entry was followed by catheter insertion. In Group-PM, the needle entry was paramedian, and the bevel was turned 45º towards the surgical site for catheter insertion. A 10 mL of 0.5% bupivacaine was administered. Postoperatively, epidural infusion was initiated using 0.125% bupivacaine with 2 μg/mL fentanyl. The time taken for catheter placement, onset of motor and sensory blockade, maximum sensory level attained, duration of sensory blockade, consumption of local anaesthetics, haemodynamic profile, and the need for rescue analgesia were monitored. Continuous data were analysed using the Student's t-test, and categorical data were analysed using the Chi-squared test with International Business Machines (IBM) statistical product and service solutions software version 27.0 Results: Both groups were comparable with respect to demographics. The mean age in Group-ML was 40.9±25.93 years, while in Group-PM it was 41.028±20.576 years, with a p-value of 0.981. The mean BMI in Group-ML was 24.91±2.998 kg/m2 , while in Group-PM it was 24.96±2.527 kg/m2 , which was statistically insignificant with a p-value of 0.944. A total of 21 males in Group-ML and 28 males in Group-PM participated in the study; the distribution was found to be statistically insignificant with a p-value of 0.067. The time taken for the placement of the epidural catheter was around 288 seconds in Group-ML and 322 seconds in Group-PM, with a p-value of 0.0035. The onset of sensory block was around 17 minutes in Group-ML and 13 minutes in Group-PM, respectively, with a p-value of 0.0001. The duration of sensory block or the time taken for two-segment regression of level was around 102 minutes and 128 minutes in Group-ML and Group-PM, respectively (p-value 0.0001). The rescue analgesic was required in seven patients of Group-ML and none in Group-PM, with a p-value of 0.005. The haemodynamic profile intra and postoperatively and postoperative VAS score were statistically insignificant between the groups. Conclusion: The paramedian approach and epidural catheter insertion with the needle rotated at an angle of 45º towards the surgical side provide a rapid onset of the sensory and motor block with extended duration of the sensory blockade and reduced consumption of local anaesthetics.

Broken epidural catheter: individualize your management

BackgroundEpidural anaesthesia is one of the most used neuraxial anaesthesia techniques. It has been utilized as the principal anaesthesia modality involving lower limb surgery. Breakage of epidural catheters is an unusual occurrence whose subsequent therapy lacks uniformity due to the absence of a consensus and defined standards.Case presentationA 39-year-old male with no comorbidities was scheduled for right lower limb reconstruction surgery due to non-union of the tibia. Combined spinal-epidural anaesthesia was planned. During epidural catheter insertion, there was difficulty threading the catheter, and upon its removal, a long segment of catheter (8 cm) was left inside the body. Following informed consent from the patient, the retained fragment was surgically extracted in the same sitting under general anaesthesia.ConclusionsEven when faced with such a circumstance, it is best to explore surgically and remove a long segment broken catheter to allay patient anxiety.

Comparative Study of Post-Operative Analgesic Effect between Wound Site Infiltration and Bilateral U/S Guided Transversus Abdominis Plane Block with 0.25% Bupivacaine after Cesarean Section

Abstract Background The analgesic regimen needs to meet the goals of providing safe, effective analgesia, with minimal side effects for the patient, together with inhibition of trauma –induced nociceptive impulses. Objectives This study assessed the postoperative analgesic efficacy of transversus abdominis plane (TAP) block compared to local wound infiltration after cesarean section regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. All patients were informed with the procedure US guided TAP block and were trained to use the visual analogue scale (VAS). Patients and Methods The study was conducted on 90 randomly chosen patients aged 25 to 55 years, American Society of Anesthesiologists (ASA) class I or II scheduled for cesarean section surgery in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 45 patients each: TAP block Group: received general anesthesia and 20 ml of 0.25% bupivacaine on each side by midaxillary approach under ultrasound guidance. Local wound infiltration: received general anesthesia and with 0.25% bupivacaine 30 ml at surgical site. Results The results of the study revealed that the Patients who received TAP block had significantly lower pain scores for 12 h after operation and decreased total need of analgesic in first 12 h post-operative compared with patients who received wound infiltration. Conclusion Bilateral TAP block was effective in reducing postoperative pain scores for 12 hours and lower total 12 hours postoperative pethidine consumption after cesarean section under general anesthesia, compared to local wound infiltration. This technique can be a promising mode of postoperative analgesia where epidural catheter insertion is contraindicated.

Investigating the Use of Nonloss of Resistance Syringes for Epidural Insertion: Experience on a Mannequin

(Int J Obstet Anesth. 2022;52:103595) The Obstetric Anaesthetists’ Association (OAA) announced a supply disruption of the Portex Loss of Resistance (LOR) Syringe, a commonly used tool for epidural catheter insertion. Several studies have shown no difference in epidural insertion success rates when using LOR to saline or air. Other methods for epidural space identification are being considered yet limited research compares specific low-resistance syringes with standard syringes. This study aimed to compare specific LOR syringes with syringes commonly used in epidural insertion.

Ultrasound-aided thoracic epidural catheter insertion: Description of a feasible technique.

Ultrasound-aided thoracic epidural catheter insertion: Description of a feasible technique.

A randomized controlled study comparing the use of ultrasound versus the conventional method in thoracic epidural catheter insertion as a pain relief method in thoracic surgeries

Background The use of epidural analgesia for the management of postoperative pain has evolved as a critical component of multimodal approach to achieve the goal of adequate analgesia with improved outcome. The introduction of ultrasound technology for epidural insertion presents a novel challenge of acquiring new knowledge and skill set. As with acquiring any new skill, there will be initial challenges for both the novice and experienced anesthesiologist. From correlating anatomy with sonoanatomy and visualizing needles and fluid dynamics in real-time below the skin surface, ultrasound provides opportunities and unique challenges for vascular access and regional anesthesia. Purpose The purpose of this study was to evaluate the utility of ultrasound in the process of epidural catheter inserion and whether it can replace the conventional loss-of-resistance (LOS) technique or at least help with better performance by the staff. Patients and methods A total of 30 patients scheduled for thoracotomy were randomly categorized by closed envelopes method into two equal groups (15 patients each): group I patients received epidural anesthesia with ultasound guidance, and group II patients received epidural anesthesia with the conventional palpation technique. We recorded time from first puncture till LOS, number of skin punctures till LOS, redirections, and bone contacts. Failure and complications were recorded as well. Patient satisfaction was assessed after catheter insertion and removal, which was 24 h postoperatively in the postanesthesia care unit. Results A significant increase in insertion time was recorded in group I (P<0.001). The number of skin punctures till LOS was significantly lower in group I (P=0.043), and needle redirections were also lower in group I (P=0.020). Vertebrae were less hit by the needle in group I (P=0.026). A case of epidural failure was recorded in group II, and also an accidental hemorrhagic tap was recorded in the same group. Patient satisfaction both after catheter insertion and removal was higher in group I (P=0.031 and 0.002, respectively). Conclusion From the primary endpoints assessed in this work, one can declare that usage of ultrasound had consumed time owing to lack of experience by the operator, yet it led to less puncture attempts, redirections, and bone contacts and reduced failure rates and complication rates, which led to increased satisfaction. The technique requires more practice and training to familiarize anesthesia staff with it to lower the procedure time.

Cutaneous fluid leak from the epidural puncture site after insertion of a thoracic epidural catheter: A unusual cause.

Cutaneous fluid leak from the epidural puncture site after insertion of a thoracic epidural catheter: A unusual cause.

Redistributional Hypothermia Prevention by Prewarming with Forced-Air: Exploratory, Open, Randomized, Clinical Trial of Efficacy.

Avoiding redistributional hypothermia that decreases core temperature by 0.5-1.5°C within the 1st hour of surgery is difficult. The efficacy of prewarming using a forced-air warming (FAW) device with a lower-body blanket on redistribution hypothermia during epidural procedures have not been investigated. After ethics approval, 113 patients undergoing laparoscopic surgery under general anesthesia combined with epidural anesthesia were enrolled. Intervention (prewarming) group patients who were warmed from operating room entry, including during epidural anesthesia, was compared with the control group that was warmed from just before surgery started. In total, 104 patients (52, control; 52, prewarming) were analyzed. In the prewarming group, compared to the control group, the core temperature 20 minutes after anesthesia induction (36.9 ± 0.4 vs. 37.1 ± 0.4°C, p < 0.02) was significantly higher. The core temperature was higher in the prewarming group than in the control group until 3 hours after the surgery. In the prewarming group, compared to the control group, the core temperature-time integral below baseline till 180 minutes after surgery start (65.1 ± 64.0 vs. 8.1 ± 18.6°C/min, p < 0.0001) or 30 minutes after anesthesia induction (5.3 ± 6.2 vs. 2.0 ± 4.7°C/min, p < 0.0001) were significantly smaller. Postoperative shivering was comparable between the groups. Prewarming during epidural catheter insertion with a FAW device could safely prevent a core temperature decrease induced by redistribution or heat loss without additional preparation, effort, space, or time requirements.

Procedural Aspects of Epidural Catheter Placement: A Prospective Observational Study of 173 Epidural Catheter Insertions

The risks and benefits of epidural analgesia have been studied extensively, but information regarding many other aspects of epidural catheter insertion is limited. The authors aimed to add information regarding procedural pain, procedure duration, failure rates, and the effect of experience to the ongoing discussion on this procedure. A prospective observational study. A Danish tertiary hospital. Patients scheduled to undergo video-assisted thoracic surgery. Epidural catheter insertion in 173 patients undergoing video-assisted thoracic surgery for lung cancer. The authors recorded the time required for the epidural insertion procedure, the attempts used, insertion level, access use, patient position, placement technique used, and the designation of the physician placing the catheter. Furthermore, the authors asked the patients to evaluate the expected procedural pain, and after the procedure the authors asked them to evaluate the actual level of pain experienced. Six and 24 months after discharge, the authors examined persistent sequelae by using questionnaire assessments. The median procedure duration was 13 minutes, with 75% of the catheters placed within 22 minutes. Actual procedure-related pain (mean score [M]=3.5, SD=2.0) was significantly (p < 0.0001) less than that expected before the procedure (M=4.9, SD=2.0). The patients' expected pain, attempts required for successful catheter placement, and approach used to access the epidural space significantly affected the actual procedure-related pain (p=0.001, p ≤ 0.003, and p=0.023, respectively). Persistent pain and sensory disturbances were observed in 11% and 4% of the patients, respectively, after 6 months and in 6% and 4% of the patients, respectively, after 2 years. In this study, the authors examined several lesser-known aspects of epidural procedures. The use of epidural analgesia as part of the pain management plan after surgery requires a more complex evaluation instead of merely discussing the possibility of procedural infections, hematomas, or neurologic injuries. The procedure time, patients' expected and experienced pain related to the procedure, and the potential long-term side effects should be a part of the decision-making process.

Allodynia in bilateral lower limbs after epidural catheter insertion.

Allodynia in bilateral lower limbs after epidural catheter insertion.

Long-term complications of unintentional dural puncture during labor epidural analgesia: a case–control study

IntroductionEpidural analgesia is the preferred method to manage pain during labor and delivery. The insertion of the epidural catheter can be complicated by unintentional dural puncture that may result in...

Abstract No. : ABS0549: Comparison of dural puncture epidural technique with combined spinal epidural Technique for labour analgesia. A prospective randomised study.

Background & Aims:The Dural puncture epidural technique (DPE) is where the dura is punctured but no intrathecal drug is given. thus avoiding potential side effects of intrathecal drugs. The goal of our study was to find whether DPE technique provides safe and better quality of analgesia compared to CSE.Methods:60 parturients of American Society of Anesthesiologists ( ASA) grade ll were divided into two groups. In DPE group, dura was punctured with spinal needle followed by insertion of epidural catheter. A test dose of 3ml of 2% lignocaine with adrenaline was given followed by 5ml of 0.125% bupivacaine. In CSE group, 1.25mg of 0.25% plain bupivacaine with 20µg fentanyl wasgiven in subarachnoid space and epidural catheter was threaded Background infusions were given in both the groups.Results:The onset time of analgesia was 460.67+/-72.96 seconds (7.67 min.) in DPE. While with CSE it was223.33+/-50 seconds (3.8 min). The time for the 1st top up, was 135.23± 22.05 minutes in group DPE and 135.67 ± 13.19 minutes in group CSE. The mean duration of labour was 245.87 ± 31.18 minutes in Group DPE and 238.23 ± 34.03 minutes in CSE group (p =0.369). The maternal haemodynamic changes were similar in both study groups. In group DPE, 80% (24) patients had normal vaginal delivery 3 (10%) underwent lower segment caesarean section (LSCS), 3 (10%) had instrumental delivery. In group CSE 73.3% (22) patients had normal vaginal delivery while 13 % (4) each underwent LSCS and instrumental forceps delivery (p=0.83). There was no significant difference in motor block between the two groups( p values greater than 0.05). Eight patients (26.7%) reported pruritus in CSE group while none in the group DPE (p = 0.005). Seven patients reported nausea in group CSE against one in group DPE (p =0.05).Foetal bradycardia was more in CSE(6) compared to DPE(1)( p=0.10). APGAR score was more than 7 in both groups.Conclusion:The quality of analgesia was good with both DPE and CSE, though onset of analgesia was slightly faster in CSE group. The maternal and foetal outcomes were better with DPE group.

Comparison of Ultrasound Guided Transversus Abdominis Plane Block versus Intraperitoneal and Perioportal Bupivacaine Infiltration in Post Operative Analgesia after Laparoscopic Cholecystectomy

Abstract Background Laparoscopic cholecystectomy is one of the commonest elective laparoscopic surgeries done in our setup. We found that post-surgery most of the patients complain of incisional pain at port sites and right shoulder tip pain. Objectives The aim of this study has been to test the efficacy of TAP block versus intraperitoneal and periportal infilteration with local anesthetic agent specially to provide postoperative analgesia after laparoscopic cholecystectomy. Patients and Methods All patients were informed with the procedure US guided TAP block and were trained to use the visual analogue scale (VAS). The study was conducted on 50 randomly chosen patients aged 20 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled for elective laparoscopic cholecystectomy in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 25 patients each: TAP block Group: received general anaesthesia and 20 ml of 0.25% bupivacaine on each side by midaxillary approach under ultrasound guidance. Intraperitoneal and periportal infiltration Group: received general anaesthesia and 20 ml of 0.25% bupivacaine was injected under the direct vision into the hepato-diaphragmatic space, near and above the hepato-duodenal ligament and above the gall bladder before removal of the probes, also 20ml of 0.25% bupivacaine was injected at the port sites at the end of operation. Results The Patients receiving TAP block had significantly lower pain scores at rest for 6 hrs and upon coughing for 6 hrs also after operation and decrease total need of analgesic in first 24 h post operative compared with patients who received Intraperitoneal and periportal infiltration. Conclusion Bilateral TAP block was effective in reducing postoperative pain scores at rest and upon coughing for 6-12 hours and lower total 24-h postoperative opioid and analgesic consumption after laparoscopic cholecystectomy under general anesthesia, compared to intraperitoneal and periportal infiltration. This technique can be a promising mode of postoperative analgesia where epidural catheter insertion is contraindicated.

Comparison between Ultrasound Guided Transversus Abdominis Plane Block versus Ultrasound Guided IlioInguinal/Iliohypogastric Nerves Block for Postoperative Analgesia in Patients Undergoing Unilateral Oblique Inguinal Hernia Repair Under General Anesthesia

Abstract Background Inguinal hernia considered the third common disease in surgeries for adults after acute appendicitis and proctologic disorders. About 20 millions of inguinal hernia repairs are performed globally. Inguinal herniorrhaphy is frequently associated with persistent postoperative pain. Objectives The aim of this study is to assess the postoperative analgesic efficacy of transversus abdominis plane (TAP) block compared to ilioinguinal/iliohypogastric nerves block after unilateral inguinal hernia repair regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. Patients and Methods The study was conducted on 70 randomly chosen patients aged 21 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled for elective unilateral open inguinal hernia repair under general anesthesia, in Ain Shams University Hospitals after approval of the medical ethical committee. Results The results of the study revealed that there is Patients receiving TAP block had significantly lower pain scores at 4 h and 6 h after operation, delay time for rescue analgesia and decrease total need of analgesic in first 24 h post operative compared with patients who received ilioinguinal/ iliohypogastric nerves block. Conclusion TAP block was effective in reducing postoperative pain scores for 4-6 hours, lowering total 24-h postoperative opioid and analgesic consumption and delaying the need for rescue analgesia after inguinal hernia repair under general anesthesia, compared to ilioinguinal/iliohypogastric nerves block. This technique can be a promising mode of postoperative analgesia when epidural catheter insertion is contraindicated.

Proficiency-based progression training: implementing a novel approach to training for epidural analgesia in labour

BackgroundEpidural insertion is a challenging anaesthetic procedural skill to learn and may require up to 75 attempts to achieve competency. Proficiency-based progression (PbP) training based on unambiguously defined metrics was associated with a 53% reduction in epidural failure rate. The aim of this observational study was to examine the feasibility of implementation of innovative PbP training for labour epidural insertion performed by novices in a busy tertiary hospital. MethodsAll trainees who were scheduled to commence their obstetric anaesthesia training were invited to participate. Novices undertook intensive PbP training with one-to-one supervision by an anaesthetist trained in PbP. Trainees proceeded to the clinical phase only after attaining the pre-defined proficiency benchmark. All subsequent attempts at labour epidural catheter placement were evaluated. ResultsAll 12 novice trainees who were scheduled for their initial exposure to obstetric anaesthesia completed PbP training in epidural catheter insertion successfully. The average duration of the training courses was 70 (SD 11) min. Trainee characteristics were broadly similar. They performed a total of 180 labour epidural catheter placements with an overall epidural failure rate of 12.2% (22/180). The proportion of supervisor takeover was 6% (11/179). The incidence of complications was 4% (8/180) and difficulty in epidural catheter insertion due to patient factors was 16% (29/180). Patient satisfaction rates were 80% (satisfied or very satisfied), with 20% unsatisfied with their experience of epidural insertion. ConclusionIn our experience, PbP training in epidural placement is feasible within existing departmental resources in a busy tertiary teaching hospital setting.

Epidural analgesia versus intravenous analgesia after minimally invasive repair of pectus excavatum in pediatric patients: a systematic review and meta-analysis.

BackgroundPostoperative pain control after the minimally invasive repair of pectus excavatum (MIRPE) is essential, but there is a controversy about a better analgesic method between epidural and intravenous (IV) analgesia. This systematic review and meta-analysis aimed to compare the effect of epidural versus IV analgesia following MIRPE. MethodsWe searched PubMed, MEDLINE, Embase, Cochrane Central Register, and ClinicalTrials.gov for randomized controlled trials (RCTs) dated up to 31st May 2021. The primary outcome was the area under the curve (AUC) of the weighted mean visual analog scale (VAS) after MIRPE. The secondary outcomes were postoperative nausea, operation time, total operating room time, and postoperative length of hospital stay.ResultsFour RCTs involving 243 patients were finally included in this meta-analysis. The AUC of the weighted mean VAS was 343.62 in the epidural group and 375.24 in the IV group. The epidural group showed lower VAS than the IV group at 12 to 48 h after the surgery. Postoperative nausea, operation time and length of hospital stay was not different between two groups. The epidural group had a significantly longer total operating room time due to epidural catheter insertion time.ConclusionsEpidural analgesia after the MIRPE had a better analgesic effect than IV analgesia. However, IV analgesia may also be a viable option, and physicians should wisely choose analgesic modalities after MIRPE.