Letters to the Editor: Letter to the Editor
To the Editor
With great interest, we read the report by Patel et al1 involving the use of electric stimulation of epidural catheters in pregnant women. As the authors rightly point out, epidural catheters, even more so than in nonobstetric patients, have high failure rates and replacement rates. Some studies report failure rates as high as 27%.2
One of the more common reasons for inadequate labor analgesia and ineffective conversion to surgical anesthesia is a 1-sided effect. Therefore, it is interesting that the authors report a unilateral motor stimulation in more than 95% of the patients, yet the groups demonstrated a symmetrical block after 20 minutes in 86% (uniport) and 81% (multiport), respectively. Presumably, this discrepancy lies in the method of electrical stimulation rather than the position of the catheter in the epidural space.
It would be interesting to know whether the authors consider any possible modifications to the method of stimulation that would allow the prediction of a bilateral block.
Ellis Muggleton, BMedSci, MBChB, MRCP, EDICDepartment of Anesthesiology and Intensive Care MedicineRotkreuzklinikum MünchenMunich, GermanyEllis.firstname.lastname@example.org
Tuelin Muggleton, MDDepartment of Anesthesiology and Intensive Care MedicineRotkreuzklinikum MünchenMunich, GermanyTuelin.email@example.com
1. Patel R, Arzola C, Petrounevitch V, et al. Response patterns to the electric stimulation of epidural catheters in pregnant women: a randomized controlled trial of uniport versus multiport catheters. Anesth Analg. 2016;123:950–954.
2. Ready LB. Acute pain: lessons learned from 25,000 patients. Reg Anesth Pain Med. 1999;24:499–505.