• H R Muñoz, J A Dagnino, M Allende, G J Bugedo, J M Montes, and O G Cherres.
• Departamento de Anestesiología, Hospital Clínico, Universidad Católica de Chile, Santiago.
• Reg Anesth. 1993 Nov 1;18(6):331-4.

Background And ObjectivesParesthesias and unblocked segments during continuous epidural anesthesia--sometimes leading to higher doses of local anesthetics--can increase the risk of this technique. A cephalad insertion of the epidural catheter might decrease the incidence of these problems, but this has not been evaluated before in a controlled study.MethodsIn a prospective, double-blind, randomized study, we compared the incidence of paresthesias during catheter insertion and the failure rate of continuous epidural anesthesia in two groups of obstetric patients. In group 1 (n = 52), the Tuohy needle bevel was directed cephalad during catheter insertion. In group 2 (n = 53), it was directed caudad. The catheter was introduced 4-5 cm into the epidural space, and bupivacaine 25 mg plus fentanyl 50 micrograms were administered through it.ResultsTwenty percent of the patients in group 1 had paresthesias versus 40% in group 2 (p = 0.0249; 95% confidence interval of the difference 1-40%); intensity of paresthesias was greater in group 2. Pain relief was complete in 75% and 80% of the patients in groups 1 and 2, respectively (NS); three patients in group 1 and one in group 2 had unblocked segments (NS).ConclusionsOur results support the contention that the catheter should be directed cephalad during insertion for continuous epidural anesthesia.

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