paresthesia with labor epidural catheter insertion

[caveat87]

I do not routinely get any paresthesia with touhy needle insertion but i have noticed probably about 50% of patients note a left or right sided leg paresthesia with epidural catheter insertion. if it is severe i will withdraw the needle, rotate the touhy and obtain a new LOR before re-attempting insertion. the literature seems to suggest this is fairly common and there is no clear link between paresthesia and nerve injury. I have tried boluses of NS into the epidural space before insertion, slowing catheter insertion, etc. and this makes no difference it seems. Is this something i should worry about? Do you all have any tricks to avoid this unpleasant sensation for the patient?

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[fittipaldi1of1]

I pause and just keep threading, then make sure it resolves before I give any local. It always goes away in a few seconds for me.
If it were to stay, I’d pull it out and wait for it to resolve then try again. Or completely abort if it doesn’t resolve.. you wouldn’t want there to be a paresthesia then give local and cover it up and not know your causing nerve impingement/damage

 

[AdmiralChz]

Do you all have any tricks to avoid this unpleasant sensation for the patient?

I warn them that it’s probably coming and should only last a brief moment. Patients don’t seem too concerned with it in my opinion (much less so than forceful contractions or even skin local). If it persisted I agree with above I’d probably take everything out and try again.

 

[somedumbDO]

I bolus saline into epidural space then place catheters, I rarely get a parasthesia if so do the above

 

[facted]

Depends also on stiffness of catheters. Softer catheters don't get it as much I find. With the stiff catheters we are currently using, I routinely get parasthesias with the catheter even after bolusing 10ml saline to open the space.

After I'm done placing the catheter, I make sure it resolved before I give test dose. Haven't had an issues with this approach.