Combined Double-Segment Spinal-Epidural Anesthesia With Fixation of the Epidural Catheter in the Subcutaneous Canal Using a Modified Spinal Needle

Aim of study To develop a new safe and reliable method of fixing an epidural catheter (EC), to study and compare the results of this method of fixing EC in the subcutaneous canal using a modified spinal needle (MSN) and an adhesive tape with a standard method of fixing an EC using only an adhesive tape when performing the combined double-segment spinal-epidural anesthesia (CDSEA) in the surgical treatment of fractures of the bones of the lower limb.

Material and methods A comparative study of two methods of EC fixation was carried out in patients undergoing CDSEA during the surgical treatment of fractures of the bones of the lower limb. The patients were divided into two groups. The Group 1 (comparison, n=65), where EC was fixed at the site of epidural access with adhesive tape and the Group 2 (study, n=65), where EC was fixed in the subcutaneous canal using MSN and adhesive tape at the site of EC exit on the skin.

Results In the study group, where EC was fixed in the subcutaneous canal using MSN and adhesive tape at the site of EC exit to the skin, there were 32.3% fewer cases with clinically significant dislocation (more than 15 to 30 mm) than in the comparison group, where EC was fixed at the site of epidural access only with adhesive tape.

Conclusions A used spinal needle in a modified version can be used to perform EC in the subcutaneous canal. The dimensions of the MSN allow tunneling of the EC less traumatic and at a great distance from the site of the epidural access, which provides more reliable fixation of the EC, the number of cases with clinically significant + dislocation decreases, this allows for a longer and better postoperative epidural analgesia. This method does not solve all the problems of EC fixation; it is required to develop new methods of EC fixation, including fixation in the subcutaneous canal.

1. Curelaru I. Long duration subarachnoid anesthesia with continuous epidural block. Prakt Anaesth. 1979;14(1):71–78. PMID: 419062

2. Mane RS, Patil MC, Kedareshvara KS, Sanikop CS. Combined spinal epidural anesthesia for laparoscopic appendectomy in adults: A case series. Saudi J Anaesth. 2012;6(1):27–30. PMID: 22412773 https://doi.org/10.4103/1658-354X.93051

3. Koryachkin VA. Neyroaksial’nye blokady. Saint Petersburg: ELBI-SPb Publ.; 2013. pp. 283–284. (in Russ.)

4. Backe SK, Sheikh Z, Wilson R, Lyons GR. Combined epidural/spinal anaesthesia: Needle-through-needle or separate spaces? Eur J Anaesthesiol. 2004;21(11):854–857. PMID: 15717699 https://doi.org/10.1017/s0265021504000171

5. Casati A, D’ambrosio A, De Negri P, Fanelli G, Tageriello V, Tarantino F. A clinical comparison between needle-through-needle and double segment techniques for combined spinal and epidural anesthesia. Reg Anesth Pain Med. 1998;23(4):390–394. PMID: 9690592 https://doi.org/10.1016/s1098-7339(98)90013-x

6. Sadashivaiah J, Wilson R, McLure H, Lyons G. Double-space combined spinal-epidural technique for elective caesarean section: A review of 10 years’ experience in a UK teaching maternity unit. Int J Obstet Anesth. 2010;19(2):183–187. PMID: 19945843 https://doi.org/10.1016/j.ijoa.2009.06.005

7. Collis RE, Baxandall ML, Srikantharajah ID, Edge G, Kadim MY, Morgan BM. Combined spinal epidural analgesia with ability to walk throughout labour. Lancet. 1993; 341(8847):767–768. PMID: 8095677 https://doi.org/10.1016/0140-6736(93)90548-u

8. Epshteyn SL, Karpov IA, Ovechkin AM. Analiz effektivnosti razlichnykh sposobov fiksatsii epidural’nogo katetera. (in Russ.) Available at: http://www.critical.ru/RegionarSchool/publications/0076/ [Accessed Apr 18, 2022]

9. Kumar N, Chambers WA. Tunnelling epidural catheters: a worthwhile exercise? Anaesthesia. 2000;55(7):625–626. PMID: 10919415 https://doi.org/10.1046/j.1365-2044.2000.01645.x

10. Kost-Byerly S, Tobin JR, Greenberg RS, Billett C, Zahurak M, Yaster M. Bacterial colonization and infection rate of continuous epidural catheters in children. Anesth Analg. 1998;86(4):712–716. PMID: 9539589 https://doi.org/10.1097/00000539-199804000-00007

11. Bubeck J, Boos K, Krause H, Thies KC. Subcutaneous tunneling of caudal catheters reduces the rate of bacterial colonization to that of lumbar epidural catheters. Anesth Analg. 2004;99(3):689–693. PMID: 15333395 https://doi.org/10.1213/01.ANE.0000130023.48259.FB

12. Bishton IM, Martin PH, Vernon JM, Liu WH. Factor influencingepidural catheter migration. Anaesthesia. 1992;47(7):610–612. PMID: 1626676 https://doi.org/10.1111/j.1365-2044.1992.tb02337.x

13. Crosby ET. Epidural catheter migration during labour: a hypothesis for inadequate analgesia. Can J Anaesth. 1990;37(7):789–793. PMID: 2225296 https://doi.org/10.1007/BF03006538

14. Coupé M, al-Shaikh B. Evaluation of a new epidural fixation device. Anaesthesia. 1999;54(1):98–99. PMID: 10209396 https://doi.org/10.1046/j.1365-2044.1999.0759v.x

15. Bougher R, Corbett A, Ramage D. The effect of tunnelling on epidural catheter migration. Anaesthesia. 1996;51(2):191–194. PMID: 8779382 https://doi.org/10.1111/j.1365-2044.1996.tb07714.x

16. Il’in SA, Subbotin VV, Mironenko AV. Bezopasnyy sposob postanovki epidural’nogo katetera v «tunnele» dlya prodlennoy anestezii. osti razlichnykh sposobov fiksatsii epidural’nogo katetera. Patent RU 2301 083 C2. IPC A61M 19/00 (2006. 01). (in Russ.)

17. Kuz’min VV, Egorov VM. Sposob fiksatsii epidural’nogo katetera pri prodlennoy epidural’noy anestezii. Patent RU 2 30 772 C1 A61M 19/00 (2006.01).

18. Nikolaev AV. Ustroystvo dlya formirovaniya podkozhnogo tunnelya i provedeniya epidural’nogo katetera. Patent RU 26426 U1. IPC A61M 25/06 (2000. 01).

19. Koryachkin VA. Neyroaksial’nye blokady. Saint Petersburg: ELBI-SPb Publ.; 2013. pp. 276–277. (in Russ.)

20. Tripathi M, Pandey M. Epidural catheter fixation: subcutaneous tunnelling with a loop to prevent displacement. Anaesthesia. 2000;55(11):1113–1116. PMID: 11069341 https://doi.org/10.1046/j.1365-2044.2000.01547-2.x

21. Marchenko AP, Yamshchikov ON, Emel’yanov SA. Sposob provedeniya epidural’nogo katetera v podkozhnom kanale pri provedenii dvukhsegmentarnoy spinal’no-epidural’noy anestezii. Patent RU No 2 727 234 S 1 klass IPC A 61 19/00.

22. Ovechkin AM, Karpov IA, Lyusev SV. Migratsiya epidural’nogo katetera kak odna iz osnovnykh prichin neadekvatnoy epidural’noy anal’gezii: sostoyanie problemy i sposoby ee resheniya. Available at: http://www.medlinks.ru/article.php?sid=19610 [Accessed Apr 18, 2022]

23. Beilin Y, Bernstein H, Zucker-Pinchoff B. The optimal distance that a multiorifice epidural catheter should be threaded into the epidural space. Anesth Analg. 1995;81(2):301–304. PMID: 7618719 https://doi.org/10.1097/00000539-199508000-00016