There are two occasions when placement of an epidural catheter can be uncomfortable and both are preventable. I will just address the second one here. In my view, the catheter in this video is passed much too briskly. We know that the catheter is going in a place that is inhabited by many nerves. I think the catheter should be passed at the same speed that one would put in a contact lens. As we cannot see where the epidural catheter is going, it is inevitable that on occasion, the catheter will brush up against a nerve in the epidural space and cause a parasthesia.....a shocking sensation that can go down one leg and is quite unpleasant. It only stands to reason that the more briskly the catheter is passed, the more likely an unpleasant parasthesia will occur. I'm not going to suggest that I NEVER had a parasthesia while performing an epidural but when it did occur, it was very minimal and not of the sort that caused the patient to cry out or end up on the other side of the bed and be remembered for years to come. As well, passing the catheter at a slower, more gentle pace, makes it less likely that a vessel will be cannulated in the epidural space. Yes, passing the catheter briskly certainly LOOKS cool but on the occasion that you get a parasthesia or a blood return, it is anything but.
great comment and very useful point to make. presuming the 'first occasion' of discomfort you're referring to is stinging at lidocaine infiltration.. though that's pretty much unavoidable
Could be worse… a shot in the eye
Is the ampule sterile
Yes. Most kits come with lidocaine for both local and a test dose
There are two occasions when placement of an epidural catheter can be uncomfortable and both are preventable. I will just address the second one here. In my view, the catheter in this video is passed much too briskly. We know that the catheter is going in a place that is inhabited by many nerves. I think the catheter should be passed at the same speed that one would put in a contact lens. As we cannot see where the epidural catheter is going, it is inevitable that on occasion, the catheter will brush up against a nerve in the epidural space and cause a parasthesia.....a shocking sensation that can go down one leg and is quite unpleasant. It only stands to reason that the more briskly the catheter is passed, the more likely an unpleasant parasthesia will occur. I'm not going to suggest that I NEVER had a parasthesia while performing an epidural but when it did occur, it was very minimal and not of the sort that caused the patient to cry out or end up on the other side of the bed and be remembered for years to come. As well, passing the catheter at a slower, more gentle pace, makes it less likely that a vessel will be cannulated in the epidural space. Yes, passing the catheter briskly certainly LOOKS cool but on the occasion that you get a parasthesia or a blood return, it is anything but.
great comment and very useful point to make.
presuming the 'first occasion' of discomfort you're referring to is stinging at lidocaine infiltration.. though that's pretty much unavoidable
Lol you stole that video
Tq