ADMINISTRATION OF SALINE INJECTION IN EPIDURAL SPACE AVOIDS INTRAVASCULAR CATHETER INSERTION IN PATIENTS UNDERGOING CAESARIAN SECTION: A RANDOMIZE CONTROLLED TRIAL

Objective: The objective of this study was to determine if injecting 10 ml saline in epidural space before epidural catheter placement in pregnant women undergoing 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.