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Abstract
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Background and Aims Labour epidural failure rate has been reported as high as 7%. In up to 54% of cases, catheter migration has been identified as the cause. We hypothesized that fixing the catheter to the skin at the insertion site may contribute to catheter migration. This study investigated the feasibility of conducting a prospective, randomized controlled trial to assess the impact of a novel labour epidural catheter taping technique on catheter failure.
Methods Laboring parturients who requested epidural placement were randomized to have the catheter taped either in the standard fashion or with a length of catheter outside the insertion site which wasn’t fixed to the skin. (figure 1) Patients with BMI >50; contraindications to epidural placement or who underwent combined spinal epidural or dural puncture epidural were excluded. Twenty patients were randomized to each arm. (figure 2) The primary endpoint was the rate of epidural catheter replacement at over 120 minutes following placement.
Results Table 1 summarizes the characteristics of each group. Two catheters in the intervention group required replacement at 11 hours and 14 hours following placement. There were no epidural catheter-related complications in either group. Documentation of pain scores and dermatomal levels was inconsistent in both groups
Stratified by randomized group
Taping strategies
Conclusions An RCT comparing the two taping strategies is safe and feasible. Recruitment using verbal consent is very successful for enrollment. The rate of catheter replacement at a time greater than or equal to two hours after placement is an appropriate primary endpoint.