1: Anaesthesia. 2000 Nov;55(11):1113-6.

Epidural catheter fixation: subcutaneous tunnelling with a loop to prevent
displacement.

Tripathi M, Pandey M.

Department of Anaesthesiology and Critical Care Medicine, Sanjay Gandhi
Postgraduate Institute of Medical Sciences, Lucknow 226014, India.

A method of fixing the epidural catheter by subcutaneous tunnelling and looping
was devised. A prospective, randomised, double-blind, clinical trial was
conducted in 68 adult patients, where postoperative pain relief was planned by
thoracic epidural analgesia. In the tunnelled group (n = 34), the epidural
catheter was fixed with a subcutaneous tunnel and loop, whereas in controls (n =
34), a simple loop of epidural catheter was left over the skin without
tunnelling. An adhesive dressing was used to secure the epidural catheter. We
observed that catheter dislodgement occurred in only one patient in the
tunnelled group compared to seven control patients (21%). Despite local
inflammation of the skin around the tunnel in nine patients (27%), no catheter
infection (positive culture tip) was found in patients with subcutaneous
tunnelling for the extended period of 4-5 days. The method described allows the
catheter to lie flat on the skin and outward traction of the catheter during
movement of patients is dampened by the interposed loop which protects it
against dislodgement. At the time of removal, both ends of the catheter can be
removed under direct vision. In conclusion, we recommend this fixation method in
cases where epidural analgesia is to be used for postoperative pain relief.