• J E Spiegel, A Vasudevan, Y Li, and P E Hess.
• Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconness Medical Center, Feld. 407 East Campus, 330 Brookline Avenue, Boston, MA 02215, USA. jspiegel@bidmc.harvard.edu
• Br J Anaesth. 2009 Sep 1;103(3):400-5.

BackgroundPrevious studies evaluating stiff epidural catheters found that the three-holed design provided superior labour analgesia compared with an end-holed design. This was believed due to improved medication distribution. Recently, flexible epidural catheters with both designs have been shown to be superior to the stiff epidural catheters. We investigated the success of labour analgesia comparing the flexible three-holed with the flexible end-holed epidural catheter.MethodsThis was a prospective, single-blinded randomized study. We enrolled 500 parturients in active labour. The primary outcome was complete relief of labour pain assessed at 30 min. We also assessed the occurrence of paresthesias, intravascular and intrathecal placement, catheter replacement, and treatment of breakthrough pain during labour. Comparisons were made using Pearson's chi(2), with significance determined at the 0.05 level.ResultsFour hundred and ninety-three subjects completed the study. Initial analgesia was similar (complete labour analgesia: end-holed=85% vs 80% 95% CI of difference: 13% to -3%; P=NS). The incidence of paresthesia was similar (end-holed=3.6% vs 5.3%; P=NS). There was one intrathecal and three intravascular catheters in the three-holed group and two intravascular catheters in the end-holed group. The number of supplemental boluses and catheter replacements required during labour was similar between the groups.ConclusionsThere were no differences in the initial analgesia success rate, complications, or labour analgesia between end-hole vs multi-hole flexible epidural catheters.

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