Determination of epidural catheter placement using nerve stimulation in obstetric patients

Background and Objectives. Peripheral nerve and spinal cord stimulation techniques have been used for many years. However, electrical stimulation methods rarely have been used to confirm epidural catheter placement. This study examines the practicality of this technique to confirm epidural catheter placement in obstetric patients. Methods. Thirty-nine obstetric patients in labor were studied. An electrocardiography (ECG) adapter (Arrow-Johans) was attached to the proximal end of the epidural catheter (19-gauge Arrow Flextip plus). Then, the lowest milliamperage (1-10 mA) necessary to produce a motor response (truncal or limb movement) was applied using this setup. A positive motor response indicated that the catheter was in the epidural space. This test was performed initially after catheter insertion and repeatedly after incremental local anesthetic doses. Results. The sensitivity and specificity of the new test was 100% and 100%, respectively, with 38 true positive tests and 1 true negative test. The threshold current required to produce a positive test increased after incremental doses of local anesthetic. A case of intravascular epidural catheter migration was detected using this new test. In this case, the patient's increased threshold milliamperage returned to the baseline value within 1 hour, despite having received local anesthetic. Intravascular epidural catheter migration was subsequently confirmed by a positive epinephrine test dose. Thus, this test appears to be a potentially useful method to detect intravascular catheter placement. Conclusion. This study demonstrates that this test may have a role in improving the success rate of epidural anesthesia.