Canadian Journal of Anaesthesia

, Volume 48, Issue 1, pp 48–53 | Cite as

Lateral recumbent head-down posture for epidural catheter insertion reduces intravascular injection

  • Murat Bahar
  • Michael Chanimov
  • Mathias L. Cohen
  • Mark Friedland
  • Yelena Grinshpon
  • Rina Brenner
  • Ina Shul
  • Roman Datsky
  • Dan J. Sherman
Regional Anesthesia And Pain


Purpose: The unintentional and unrecognized cannulation of an extradural vein is a potentially serious complication of an epidural anesthetic. The present study was undertaken to assess the incidence of blood vessel puncture related to epidural catheterization performed in three different body positions. —

Methods: The study was conducted in 900 (three groups of 300) obstetric patients undergoing continuous epidural analgesia during their labour and who were randomly allocated to three groups. Epidural catheterization was performed with patients in the sitting, lateral recumbent horizontal, or lateral recumbent head-down position.

Results: There was a lower incidence of vessel cannulation when this procedure was performed in the lateral recumbent head-down position (2%) than in the lateral recumbent horizontal (6%) and in the sitting position (10.7%).

Conclusion: Adoption of the lateral recumbent head-down position for the performance of lumbar epidural blockade, in labour at term, reduces the incidence of lumbar epidural venous puncture.


Epidural Catheter Catheter Insertion Intravascular Injection Epidural Needle Epidural Puncture 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Objectif: La canulation accidentelle et passée inaperçue d’une veine péridurale représente une complication potentiellement dangereuse de l’anesthésie épidurale. La présente étude évalue l’incidence de ponction vasculaire reliée au cathétérisme péridural réalisé selon trois positions corporelles différentes.

Méthode: L’étude a été menée auprès de 900 patientes en obstétrique, trois groupes de 300 réparties au hasard, qui recevaient une analgésie épidurale pendant le travail. La mise en place d’un cathéter péridural a été réalisée en position assise, allongée sur le côté ou allongée sur le côté et tête vers le bas.

Résultats: L’incidence de ponction vasculaire est plus faible, 2%, en position allongée avec la tête vers le bas, puis de 6% en position allongée sur le côté et de 10,7% en position assise.

Conclusion: Pendant le travail dans le cas d’une grossesse à terme, l’adoption de la position allongée sur le côté et tête vers le bas, pour l’administration d’un bloc épidural, réduit l’incidence de ponction veineuse.


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Copyright information

© Canadian Anesthesiologists 2001

Authors and Affiliations

  • Murat Bahar
    • 3
  • Michael Chanimov
    • 3
  • Mathias L. Cohen
    • 3
  • Mark Friedland
    • 3
  • Yelena Grinshpon
    • 3
  • Rina Brenner
    • 3
  • Ina Shul
    • 3
  • Roman Datsky
    • 3
  • Dan J. Sherman
    • 1
    • 2
  1. 1.From the Department Obstetrics & GynecologyAssaf Harofeh Medical CenterZerifin
  2. 2.Sackler Faculty of MedicineTel-Aviv UniversityTel-AvivIsrael
  3. 3.Department of AnesthesiologyAssaf Harofeh Medical CenterZerifinIsrael

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