Accidental venous and dural puncture during epidural analgesia in obese parturients (BMI > 40 kg/m2): Three different body positions during insertion

Michael Chanimov, Shmuel Evron, Zoya Haitov, Sorin Stolero, Mathias L. Cohen, Mark Friedland, Ina Shul, Murat Bahar

Research output: Contribution to journalArticlepeer-review

Abstract

Study Objective: To assess the frequency of blood vessel punctures in morbidly obese parturients [body mass index (BMI) > 40 kg/m2] during epidural catheterization, in three different body positions. Design: Prospective, randomized study. Setting: Delivery room of a university-affiliated hospital. Patients: 347 obese parturients (BMI > 40 kg/m2) undergoing continuous epidural analgesia during labor. Interventions: Patients were randomized to undergo epidural catheterization in the sitting, lateral recumbent horizontal, or lateral recumbent head-down positions. Measurements and Main Results: A lower frequency of epidural venous cannulation was noted when this procedure was performed in the lateral recumbent head-down position (4.8%) than in the lateral recumbent horizontal (11.6%) or sitting position (18.3%) (P = 0.001). Frequency of accidental subarachnoid puncture did not differ significantly (2.5%, 2.6%, and 3.7%), respectively. Conclusion: Adoption of the lateral recumbent head-down position for the performance of lumbar epidural blockade in labor at term reduces the frequency of lumbar epidural venous puncture in obese parturients (BMI > 40 kg/m2).

Original languageEnglish
Pages (from-to)614-618
Number of pages5
JournalJournal of Clinical Anesthesia
Volume22
Issue number8
DOIs
StatePublished - Dec 2010
Externally publishedYes

Keywords

  • Anesthesia, Complications
  • Obesity
  • Patient position
  • Venous puncture

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