Effect of Epidural Needle Injection on Catheter Placement Success During Painless Labour

Effect of Epidural Needle Injection on Catheter Placement Success During Painless Labour: A Prospective Randomized Study

Epidural analgesia is the gold standard for painless labour, but successful catheter placement can be technically challenging due to anatomical and physiological changes in pregnancy. Injecting saline or local anesthetic through the epidural needle before catheter insertion has been proposed to facilitate catheter advancement by dilating the epidural space. This study aimed to evaluate the effect of epidural needle injection on the success rate and ease of catheter placement during labour analgesia.

Inclusion Criteria:

• Female patients aged 18-40 years.
• ASA physical status II or III.
• Singleton pregnancy.
• Gestational age ≥37 weeks.
• Active labour with cervical dilatation ≥3 cm.
• Cephalic presentation.
• Requesting epidural analgesia for painless labour.
• Ability to provide written informed consent.

Exclusion Criteria:

• • Refusal to participate or to sign informed consent.

  • Age <18 or >40 years.
  • ASA status ≥IV.
  • Allergy to local anesthetics or saline.
  • Coagulopathy or platelet count <100,000/mm³.
  • Local infection at the insertion site.
  • Severe spinal deformity (scoliosis, kyphosis).
  • Multiple pregnancy.
  • Non-cephalic presentation (breech, transverse).
  • Antepartum hemorrhage or placenta previa.
  • Severe preeclampsia or eclampsia.
  • Signs of fetal distress.
  • Previous lumbar spine surgery.
  • Difficult epidural anatomy (on ultrasound or palpation).
  • BMI >40 kg/m²