• Paediatric anaesthesia · Jul 2021

    Safety of an improved pediatric epidural tunneling technique for catheter shear.

    • Wataru Sakai, Shunsuke Tachibana, Tomohiro Chaki, Naofumi Nakazato, Yuri Horiguchi, Yuko Nawa, and Michiaki Yamakage.
    • Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan.
    • Paediatr Anaesth. 2021 Jul 1; 31 (7): 770-777.

    BackgroundEpidural tunneling could help with prolonged catheterization and be effective in preventing infection and dislodgement. However, epidural tunneling techniques carry a risk of catheter shear or needlestick injuries.AimsThis study aimed to examine the safety of our epidural tunneling technique in terms of catheter shear.MethodsThis study was designed as a double-blinded, single-crossover, in vitro study. Each of the operators performed two techniques to create a subcutaneous tunnel. We compared outcomes between the control tunneling technique (group C) and our improved technique (group I). Microscopic findings of catheter shear were assessed as the primary outcome. Secondary outcomes included the tension and displacement required to break the epidural catheter and the frequency of catheter breakage due to catheter shear. Data were analyzed using the Fisher's exact test and Mann-Whitney U test. A p-value of <.05 was considered statistically significant.ResultsTen catheters were assessed in each group. The frequency of catheter shear was 10% in group I and 90% in group C (odds ratio, 0.019; 95% confidence interval [CI], 0.01-0.31; p < .001). The frequency of catheter breakage due to catheter shear was significantly lower in group I (0%) than in group C (80%; p < .001). The mean tension and displacement required to break the catheter were significantly higher in group I than in group C (4.13 ± 0.37 N vs. 3.14 ± 1.00 N; mean difference, 0.99 N; 95% CI, 0.25-1.73 N; p = .013 and 222 ± 59.9 mm vs. 122 ± 77.7 mm; mean difference, 100 mm; 95% CI, 34.1-165 mm; p = .005).ConclusionsOur improved epidural tunneling technique, which was designed for pediatric cases, could reduce the risk of catheter shear.© 2021 John Wiley & Sons Ltd.

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