Superiority of multi-orifice over single-orifice epidural catheters for labor analgesia and cesarean delivery

Study Objective: To investigate whether a change from a single-orifice to multi-orifice catheter could reduce the incidence of inadequate epidural blocks requiring replacement of the epidural catheter in obstetric patients Study Design: Prospective before-after cohort study. Setting: Obstetric unit at a university hospital. Patients: 872 patients requesting epidural analgesia for vaginal delivery or cesarean section. Interventions: Patients received epidural analgesia via single-orifice (n = 433) or multi-orifice (n = 439) epidural catheters, depending on the month of the trial. Measurements and Main Results: Patient characteristics, obstetric procedure, anesthesiologist characteristics, and details of epidural placement did not differ significantly between the groups. The overall replacement rate was 14.3% in the single-orifice group versus 9.3% in the multi-orifice group (p = 0.032). There were no differences in the frequency of replacement for subarachnoid placement or migration, immediate intravascular placement, vascular migration, or absence of any block. Significantly fewer catheters were replaced in the multi-orifice group for inadequate analgesia, defined as unblocked segments or unilateral block (6.4% vs. 2.8%, p = 0.018). Paresthesias were less common in the multi-orifice group (22.4% vs. 31.5%, p = 0.003). There were no unrecognized subarachnoid or vascular catheter placements in either group. Conclusions: The multi-orifice design offers significant advantages over the single-orifice type for obstetricepidural analgesia. (C) 1997 by Elsevier Science Inc.