| A prospective comparative study of two indirect methods for confirming the localization of an epidural catheter for postoperative analgesia. | |
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MedLine Citation:
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PMID: 16301268 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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We prospectively evaluated, in randomized order, 2 indirect methods of confirming the localization of an epidural catheter for postoperative analgesia in 218 surgical patients: epidural stimulation test (EST) and epidural pressure waveform analysis (EPWA). The epidural space was localized by using a loss of resistance technique. All catheters were inserted 5 cm into the epidural space and primed with 5 mL of 0.9% normal saline. There were no differences between the methods: the positive predictive value and specificity were high (100% in both groups), but the sensitivity was moderate (80% for EST and 81% for EPWA) and the negative predictive value was low (16% for EST and 17% for EPWA). Combining both methods yielded better sensitivity (97%) and negative predictive value (57%) (P < 0.001). The sensitivity of EST was increased to 87% (P < 0.05) if sensory response was included as well as motor response for stimulation less than 10 mA. We suggest the inclusion of sensory response in the appropriate dermatome at a current <10 mA as a criterion for adequate epidural catheter localization for EST testing. EPWA sensitivity was significantly better with older patients: 94% for patients older than 80 yr compared with 63% for patients younger than 40, 73% for patients 40 to 60, and 85% for patients aged 60 to 80 yr (P = 0.03). We conclude that the two tests are comparable for confirming catheter placement. |
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Authors:
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Etienne de Medicis; Jean-Pierre Tetrault; Rene Martin; Remi Robichaud; Lucie Laroche |
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Publication Detail:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Anesthesia and analgesia Volume: 101 ISSN: 0003-2999 ISO Abbreviation: Anesth. Analg. Publication Date: 2005 Dec |
Date Detail:
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Created Date: 2005-11-22 Completed Date: 2005-12-20 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 1310650 Medline TA: Anesth Analg Country: United States |
Other Details:
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Languages: eng Pagination: 1830-3 Citation Subset: AIM; IM |
Affiliation:
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Departement d'Anesthesiologie Centre Hospitalier Universitaire de Sherbrooke 3001, 12 E. Avenue Nord Sherbrooke, Quebec, Canada J1H 5N4. estria1@globetrotter.net |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Analgesia, Epidural / methods* Catheterization / methods* Electric Stimulation Epidural Space Female Humans Male Middle Aged Pain, Postoperative / prevention & control* Prospective Studies |
| Comments/Corrections | |
Comment In:
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Anesth Analg. 2006 Sep;103(3):775-6; author reply 776
[PMID:
16931695
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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