Document Detail

A prospective comparative study of two indirect methods for confirming the localization of an epidural catheter for postoperative analgesia.
MedLine Citation:
PMID:  16301268     Owner:  NLM     Status:  MEDLINE    
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.
Etienne de Medicis; Jean-Pierre Tetrault; Rene Martin; Remi Robichaud; Lucie Laroche
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  101     ISSN:  0003-2999     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-11-22     Completed Date:  2005-12-20     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1830-3     Citation Subset:  AIM; IM    
Departement d'Anesthesiologie Centre Hospitalier Universitaire de Sherbrooke 3001, 12 E. Avenue Nord Sherbrooke, Quebec, Canada J1H 5N4.
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MeSH Terms
Aged, 80 and over
Analgesia, Epidural / methods*
Catheterization / methods*
Electric Stimulation
Epidural Space
Middle Aged
Pain, Postoperative / prevention & control*
Prospective Studies
Comment In:
Anesth Analg. 2006 Sep;103(3):775-6; author reply 776   [PMID:  16931695 ]

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