Impact of Intradermal Fixation on Epidural Catheter Durability and Dislodgement Rates.

INTRODUCTION

Epidural catheter tunnelling is recognized for reducing bacterial migration and mechanical instability, but the technique remains underutilized, and a standardized optimal method is undefined. This study describes a novel, resource-efficient method of epidural catheter tunnelling using an intravenous cannula and evaluates the incidence of catheter dislocation among injured servicemen receiving specialized medical care during the Russia-Ukraine conflict.

MATERIALS AND

METHODS

This retrospective study evaluated 71 combat casualties treated at the Military Medical Clinical Centre, Lviv, Ukraine, requiring epidural analgesia for complex lower limb injuries. Patients were divided into two cohorts based on the tunnelling technique: a control group utilizing previously reported tunnelling via an epidural needle, and an intervention group employing a novel double-tunnelling method using an 18 gauge peripheral intravenous cannula. The primary endpoint was catheter dislodgement, defined as complete removal, migration, or functional failure indicative of subcutaneous displacement.

RESULTS

The study analysed 52 control (subcutaneous) and 58 intervention (inside the dermal plane) tunnelling procedures. The control group exhibited a 3.2-times higher risk of catheter dislocation compared to the dermal plane group (p<0.05). Consequently, the novel technique significantly extended mean functional catheter duration (7.6 days [CI 3.9-11.3] vs. 4.2 days [CI 2.8-5.6]; p=0.04) and reduced the frequency of re-catheterisation. A significant trend toward requiring only a single catheter per patient was observed in the intervention group (p=0.0002). No epidural space infections occurred in either cohort.

CONCLUSIONS

The proposed tunnelling method inside the dermal plane using a peripheral IV cannula is a safe and reliable technique that significantly improves catheter fixation. By reducing dislocation risks and preventing mechanical complications, this approach offers superior durability for extended epidural analgesia, particularly in young, active trauma patients. Its ease of performance makes it highly suitable for resource-constrained military environments.