Muhammad Azam, Naila Akthar, Tanvir Akhtar Butt.
Administration of saline injection in epidural space avoids intravascular catheter insertion in patients undergoing caesarian section: a randomize controlled trail.
Ann King Edward Med Uni Jan ;21(4):257-61.

Objective: The objective of this study was to deter-mine if injecting 10 ml saline in epidural space before epidural catheter placement in pregnant women under-going cesarean section can decrease the frequency of inadvertent intravascular catheter placement. Study Design: Randomize Controlled Trail. Place and Duration of Study: Department of Anaesthesia at Gynaecology and Obstetrics operation theater, Jinnah Hospital, Lahore affiliated with College of Physician and Surgeon Pakistan from April 2008 to March 2009. Methodology: Sixty pregnant patients (ASA I and II) randomly allocated in Group A and B equally for elective cesarean section were selected. In each patient epidural space was identified with LOR technique using air in sitting position. In Group A (dry group), no saline was injected while in Group B (saline group), 10 ml saline was injected before epidural catheter placement. Using 16 G Toughy needle, catheter was inserted up to 4 cm in the epidural space. To find out inadvertent intravascular catheter placement, epidural catheter was aspirated to exclude blood. After negative aspiration, test dose of 3ml injection xylocain 2% (with adrenaline 1:200,000) was administrated and patient were monitored one minute for increase in heart rate (> 20% of baseline), tinnitus and perioral numbness. Results: In both group data collected was analyzed in SPSS version 11 and Chi-square test was applied. P value of 0.05 or less was taken significant. Percentage of positive inadvertent intravascular catheterization in term of bloody aspirate (20 and 13.3%) was not significantly different between two groups (P value = 0.488). Increase in heart rate, tinnitus and perioral numbness was not observed in any patient. Conclusion: There was no significant difference in accidental intravascular catheterization if 10 ml saline is injected through needle before catheter insertion.

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