Experience with 724 epidurograms for epidural catheter placement in pediatric anesthesia

Introduction: Epidural analgesia via continuous catheters, placed either via the caudal approach or directly at the desired level, is a commonly used technique in children. It is particularly important that these catheters are placed correctly because most are placed under general anesthesia and require deep sedation or repeat general anesthesia for replacement if malfunctioning. Ideally, correct placement should be confirmed at the time of insertion. Methods: We combined the experience of 2 academic teaching hospitals that both perform routine epidurography for the placement of epidural catheters in children. The data from 2 quality assurance regional anesthesia databases were screened for unrecognized misplacements of epidural catheters. Results: Of a total of 724 epidurograms, 45.8% were caudal catheters, 9.6% were lumbar catheters, and 32.3% were thoracic catheters. Epidurograms detected 12 (1.6%) unexpected misplacements: 4 were intrathecal, 3 were intravenous, and 3 were intraperitoneal. Conclusions: Our experiments suggest that confirmation of epidural catheter placement via epidurogram is highly efficacious. Epidurography is the only currently available technique that accomplishes all of the following: (a) confirms correct placement, (b) rules out incorrect anatomic space, and (c) predicts analgesic coverage.