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Influence of posture on the incidence of vein cannulation during epidural catheter placement

  • D. Harney (a1), C. A. Moran (a1), R. Whitty (a1), S. Harte (a1), M. Geary (a2) and J. Gardiner (a1)...



Background and objective: Epidural vein cannulation has long been recognized as a problem in parturients due to distension of epidural veins. Epidural vein engorgement is maximal when the pregnant woman is in the supine position and minimal in the lateral position. Following an initial observation of an apparently high incidence of epidural vein cannulation in the sitting position, a randomized trial was conducted to document whether such an association existed.

Methods: A total of 209 term parturients were randomized to either the sitting or lateral position (107 left lateral, 102 sitting). Epidural catheter placement was achieved using a loss of resistance to air technique with an 18-G Tuohy needle. A data sheet was completed for each patient recording patient position, patient characteristics data, stage in labour and the incidence of epidural vein cannulation. Poor labour analgesia was defined as a visual analogue scale (VAS) >40 mm on a 0–100 mm pain intensity VAS.

Results: The risk of epidural vein cannulation was significantly higher in the sitting group (16 of 102 = 15.7%) compared with the lateral position group (4 of 107 = 3.7%), P = 0.011. There was a significant association between epidural vein cannulation and poor analgesia (P = 0.006). These two variables remained independently significant on multiple regression analysis (position, P = 0.009; analgesia, P = 0.006).

Conclusions: We conclude that there is a direct correlation between the incidence of epidural vein cannulation and patient posture during epidural catheter insertion in parturients.


Corresponding author

Correspondence to: Donal Harney, Department of Clinical Pharmacology, Royal College of Surgeons Ireland, Stephens Green, Dublin 2, Ireland. E-mail:; Tel: +353 1 4022713; Fax: +353 1 4022274


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Galbert MW, Marx GF. Extradural pressures in the parturient patient. Anesthesiology 1974; 40: 499502.
Hirabyashi Y, Shimizu R, Fukuda H, Saitoh K, Igarashi T. Effects of the pregnant uterus on the extradural venous plexus in the supine and lateral positions, as determined by magnetic resonance imaging. Br J Anaesth 1997; 79: 317319.
Banwell BR, Morley-Forster P, Krause R. Decreased incidence of complications in parturients with the arrow epidural catheter. Can J Anaesth 1998; 45: 370372.
Mannion D, Walker R, Clayton K. Extradural vein puncture – an avoidable complication. Anaesthesia 1991; 46: 585587.
Beilin Y, Bernstein HH, Zucker-Oinchoff B. The optimal distance that a multiorifice epidural catheter should be threaded into the epidural space. Anesth Analg 1995; 81: 301304.
Tobias MD, Pilla MA, Rogers C, Jobes DR. Lidocaine inhibits blood coagulation: implications for epidural blood patch. Anesth Analg 1996; 82: 766769.
Colonna-Romano P, Lingaraju N, Godfrey SD, Braitman LE. Epidural test dose and intravascular injection in obstetrics; sensitivity, specificity and lowest effective dose. Anesth Analg 1992; 75: 372376.
Crawford JS. Principles and Practice of Obstetric Anaesthesia, 5th edn. Oxford: Blackwell Scientific Publications, 1984: 181.
Crosby ET. Epidural catheter migration during labour: a hypothesis for inadequate analgesia. Can J Anaesth 1990; 37: 789793.
Meiklejohn BH. Epidural air-filled bubbles and unblocked segments. Can J Anaesth 1990; 37: 390391.
Colonna-Romano P, Nagaraj L. Tests to evaluate intravenous placement of epidural catheters in labouring women: a prospective clinical study. Anesth Analg 1998; 86: 985988. Erratum in Anesth Analg 1998; 87: 3.
Tekkok IH, Cataltepe O, Tahta K, Bertan V. Extradural haematoma after continuous extradural anaesthesia. Br J Anaesth 1991; 67: 112115.
Sternlo JE, Hybbinnette CH. Spinal subdural bleeding after attempted epidural and subsequent spinal anaesthesia in a patient on thromboprophylaxis with low molecular weight heparin. Acta Anaesth Scand 1995; 39: 557559.
Hynson JM, Katz JA, Bueff HU. Epidural hematoma associated with enoxaparin. Anesth Analg 1996; 82: 10721075.
Messih MN. Epidural space pressures during pregnancy. Anaesthesia 1981; 36: 775782.


Influence of posture on the incidence of vein cannulation during epidural catheter placement

  • D. Harney (a1), C. A. Moran (a1), R. Whitty (a1), S. Harte (a1), M. Geary (a2) and J. Gardiner (a1)...


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