Decreased incidence of complications in parturients with the Arrow (FlexTip Plus™) epidural catheter

Purpose: To compare the incidence of complications during placement of Arrow (FlexTip Plus(TM)) and Concord/Portex(TM) epidural catheters in parturients receiving continuous epidural analgesia. Methods: Two hundred parturients requesting continuous epidural analgesia were prospectively and randomly assigned to receive either the Arrow (FlexTip Plus(TM)) or the Porter epidural catheter. The incidences of paresthesia, inadvertent venous cannulation and inability to thread the catheter into the epidural space were recorded. Results: A total of 222 attempts at epidural placement occurred in the parturients enrolled. The Arrow catheter displayed a lower incidence of paresthesia (3/112 vs 39/110, P < 0.0001) and venous cannulation (0/112 vs 11/110, P = 0.0007) than did the Portex catheter. The Portex catheter demonstrated a tendency towards increased inability to be advanced into the epidural space (5/110 vs 0/112, P = 0.057) in comparison to the Arrow catheter. When a Porter catheter would not advance into the epidural space (n = 5), an Arrow catheter was threaded successfully in all five cases without the need to reposition the Touhy needle. Conclusion: Compared with a less flexible catheter, the Arrow decreases the incidence of transient paresthesia and inadvertent venous cannulation, while improving the ability to thread the catheter into the epidural space. Intravascular injection, transarachnoid migration, and the rare occurrence of epidural haematoma may be further reduced with the use of flexible, soft-tip catheters.