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February
1999
A Comparison of Multiport and Uniport Epidural Catheters
in Laboring Patients
D' Angelo R, Foss ML, Livesay CH.
Anesth Analg. 1997;84 (6):1276-1279.
Commentary by Dr.
Dwane
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Review Front Page
[ see abstract below ]
Epidural catheters have either a single opening at the
patient end of the catheter (uniport) or multiple lateral holes near a
fused catheter tip (multiport). When selecting an epidural catheter, we
must weigh the benefits of rate of successful block and ease of confirming
the epidural placement against the risk of adverse outcomes: inadequate
block and intravascular or subarachnoid placement, or multicompartment
placement in the case of the multiport catheter. By multicompartment I
mean having at least one of the lateral holes in the epidural space while
another of the lateral ports is in the intravenous or subarachnoid space.
In this study comparing the use of uniport and multiport catheters in
almost 500 parturients, D'Angelo and colleagues demonstrated a significantly
lower percentage of inadequate blocks in the multiport catheter group
than in the uniport group (31.8% vs 21.2%), as well as a reduced need
for catheter manipulation (44.2% vs 31.4%). In a later communication [1],
D'Angelo explained that the still-high rate of catheter manipulation in
this study occurred because of a previous study done by his group which
demonstrated a great success in converting unblocked segments to blocked
ones by catheter manipulation prior to re-dosing of the epidural catheter.
The concern with multicompartment placement of multi-orifice catheters
has been diminished since the introduction of multiport catheters by Ward
in 1978. Because of our changes in practice, we now fractionate epidural
local anesthetic doses and also recognize that for practical purposes
each bolus is a "test dose" in it's own right. Also, for most labor analgesia
we currently use local infusions with substantially lower concentrations
of anesthetic compared to those of twenty years ago.
In summary, this article and several articles referenced in the letter
(below) support the argument that multi-orifice epidural catheters improve
the quality of analgesia in parturients. In addition to improved patient
satisfaction this should translate into reduced anesthetic intervention-i.e.,
work.
References
1. D'Angelo R, Aya GM et al (letter). Anesth Analg. 1998;86(3):676.
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Literature Review Front Page
ABSTRACT
The relative incidence of technical
difficulties associated with multiport (three lateral ports) and uniport
(single distal port) epidural catheters remains controversial. As part of
a continuing institutional evaluation of epidural catheter insertion, 500
parturients were randomized to have either a multiport or a uniport epidural
catheter inserted 6 cm into the epidural space. Multiport epidural catheters
were associated with inadequate analgesia less often and required manipulation
less often than uniport epidural catheters. The incidences of intravenous
cannulation, subsequent catheter dislodgement, and catheter replacement
were similar for each catheter type. No multiport epidural catheter was
associated with multicompartment placement. We conclude that multiport epidural
catheters are preferable for use in laboring patients since they reduce
the incidence of inadequate epidural analgesia.
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