Comparison of Epidural Catheter Migration in Three Different Techniques of Catheter Fixation: A Prospective Randomised Study

Abstract

Objective: We hypothesized that subcutaneous tunnelling will be more efficacious in preventing epidural catheter migration in the postoperative period. To compare three different fixation techniques for migration of epidural catheter in the postoperative period. Methods: Patients undergoing elective surgery with planned postoperative analgesia with lumbar epidural were included. They were divided into 3 groups based on catheter fixation – Group I: transparent adhesive dressing tape, Group II: fixator device (Locklt Plus® ) and Group III: catheter subcutaneously tunnelled vertically. The catheter mark was noted during insertion and on removal at the end of second day. The primary outcome measure was epidural catheter migration; the secondary outcome measures were complications and patient satisfaction scores. Results: Of the 170 patients recruited, 150 patients were included. The Likelihood Ratio (LR) of migration of group I in comparison to group II was 13.28 (p<0.001) while with group III was 7.06 (p=0.007). There was no significant difference between groups II and III (LR 1.12, p=0.29). The satisfaction scores were comparable among Groups II and III. There was no difference in complications among groups. Conclusion: Epidural migration is significantly reduced by both tunnelling and Lockit plus® methods in comparison to a transparent adhesive dressing in patients on continuous lumbar epidural analgesia in the first two postoperative days. The subcutaneous tunnelling method is as safe in terms of migration as the LockIt plus® method of fixation. Keywords: Catheter adverse effects, epidural analgesia, epidural catheter, postoperative pain