Impact of Epidural Failures on the Results of a Prospective, Randomized Trial

Abstract

In patients with failed epidural therapy, there is no significant difference in postoperative hospital course. Comparing those with well-functioning catheters to those in the PCA group, trial results are replicated-that is, no significant difference in length of stay, time to regular diet, or time to transition to oral medications. Therefore, failure rate in the EPI group did not influence the results of the trial.

Fluoroscopy‐assisted epidural catheter placement: an exploratory analysis of 303 pre‐operative epidurograms

“…When functioning effectively PEA leads to improved pain control with decreased opioid use, fewer opioid related side effects and, in some settings, improved clinical outcomes. [8][9][10][11][12] During a quality assessment review of our use of epidural catheters for post-thoracotomy pain, we found a failure rate (unable to place, non-functioning, dislodgement) in the first 24 h after surgery approaching 40%. 6,7 However, because the standard approach to epidural catheter placement relies on indirect anatomic assessments (palpation, 'loss of resistance', surface measurements of depth), epidural catheters can be non-functional after surgery due to failure to correctly locate or maintain the catheter in the epidural space.…”

“…The reported 'failure rates' for epidural catheters vary widely with published rates ranging from 12% to 40%, depending on experience, patient selection and the specific vertebral level chosen for catheter placement. [8][9][10][11][12] During a quality assessment review of our use of epidural catheters for post-thoracotomy pain, we found a failure rate (unable to place, non-functioning, dislodgement) in the first 24 h after surgery approaching 40%. We speculated that this high failure rate was due to a relatively large number of faculty (~35) placing or supervising thoracic epidural catheter placement and placement of most catheters by residents in training who were relatively inexperienced.…”

Raman Spectroscopy Differentiates Each Tissue from the Skin to the Spinal Cord

“…10,40-44 Additionally, the failure rate for epidural catheter analgesia is as high as 22%. 6,10,43-45 In some clinical situations, up to half of these failures may be due to an inability to accurately locate the epidural space. 41,44 As a result of the rare, but serious, complications during epidural corticosteroid injection (ESI), the U.S. Food and Drug Administration convened a panel of experts to determine practices to decrease their incidence.…”