THE DETERMINATION OF OPTIMAL FIXATION METHOD OF THE EPIDURAL CATHETER

Background. The quality of prolonged epidural analgesia depends not only on the pain level, but also on the patient`s complacency with the methods by which the fixation of the epidural catheter (EC) was performed, as well as on its efficiency. Despite the wide distribution of epidural anesthesia/analgesia by staff carrying out the operation of the EC, little attention has been paid to these factors so far.

Aim. To determine the optimal the EC fixation method by the level of comfort and efficiency during the prolonged epidural analgesia based on questionnaires of patients and doctors.

Materials and methods. The comparative research of three methods of the EC fixation in patients during the conducting of prolonged epidural anesthesia after the surgery treatment of fractures of the lower limb bones was carried out. Patients were splited into three groups: group 1 (n = 20) with the EC fixation in the site of epidural access by the fixing device Lockit; group 2 (n = 20) with the EC fixation by the methods of the tunneling under the skin with the formation of a subcutaneous catheter loop; group 3 (n = 20) with the EC fixation in the site of epidural access by the fixing device Epi-Fix. We have developed two questionnaires to choose the optimal method of the EC fixation. The first questionnaire is intended for a patient, in which he assessed the level of comfort when fixing the EC during the change of the patch or fixing device, as well as comfort during mobilization activities. The second questionnaire is intended for to assess the efficiency of EC fixation in various methods, which was filled out by the doctor who installed the EC and operated it. After that, the scores were summed and the total scores in the three study groups were compared. Informed consent was obtained from all patients to conduct a survey for the purpose of the research work.

Results. The total score in the 1st group is 200, in the 2nd group – 294, in the 3rd group – 209. Statistically significant differences were found when comparing group 3 (Epi-Fix) and group 2 (tunneling) and when comparing group 1 (Lockit) and group 2 (tunneling), where p < 0,05. No statistically significant differences were found when comparing group 1 (Lockit) and group 3 (Epi-Fix).

Conclusion. When comparing three methods of EC fixation using questionnaires for patients and doctors, the method of tunneling under the skin with the formation of a subcutaneous catheter loop was determined as optimal in terms of comfort and efficiency.

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