Cross-legged position versus traditional sitting position for epidural catheter insertion for labor analgesia: a non-randomized prospective study

The failure rate of epidural analgesia catheter insertion at the first attempt in the obstetric context ranges from 3% to 40%. 1 Eappen S. Blinn A. Segal S. Incidence of epidural catheter replacement in parturients: a retrospective chart review. Int J Obstet Anesth. 1998; 7: 220-225 Abstract Full Text PDF PubMed Scopus (96) Google Scholar , 2 Kula A.O. Riess M.L. Ellinas E.H. Increasing body mass index predicts increasing difficulty, failure rate, and time to discovery of failure of epidural anesthesia in laboring patients. J Clin Anesth. 2017; 37: 154-158 Crossref PubMed Scopus (33) Google Scholar , 3 Rajagopalan S. Shah K. Guffey D. Tran C. Suresh M. Wali A. Predictors of difficult epidural placement in pregnant women: a trainees' perspective. J Anaesthesiol Clin Pharmacol. 2019; 35: 548-552 Crossref PubMed Scopus (2) Google Scholar This wide range may be explained by variable definitions of failure, which sometimes include difficulty with insertion. Indeed, it could be considered that there is a strong relationship between these two situations since parturients in whom insertion is difficult are at higher risk of failure. Factors associated with difficult insertion include difficulties in bone structure palpation, obesity, spinal deformity, inability to maintain an adequate parturient position, and limited operator experience. 4 Faitot V. Ourchane R. Dahmani S. et al. An observational study of factors leading to difficulty in resident anaesthesiologists identifying the epidural space in obstetric patients. Int J Obstet Anesth. 2011; 20: 124-127 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar , 5 Guglielminotti J. Mentre F. Bedairia E. Montravers P. Longrois D. Development and evaluation of a score to predict difficult epidural placement during labor. Reg Anesth Pain Med. 2013; 38: 233-238 Crossref PubMed Scopus (17) Google Scholar , 6 Thangamuthu A. Russell I.F. Purva M. Epidural failure rate using a standardised definition. Int J Obstet Anesth. 2013; 22: 310-315 Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar In different populations at term pregnancy, optimization of positioning by means of a cross-legged sitting position (CSP) versus traditional sitting position (TSP) has been suggested in a study using ultrasound measurements. 7 Sharma M. Qasem F. Sebbag I. Jones P.M. Singh S.I. The crossed-leg position increases the dimensions within the acoustic target window for neuraxial needle placement in term pregnancy: a prospective observational study. Int J Obstet Anesth. 2020; 44: 106-111 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar Also, one study comparing CSP and TSP for success of epidural catheter insertion in Indian women in labor demonstrated the superiority of a CSP. 8 Puthenveettil N. Sandhya S. Joseph N. Nair S. Paul J. Comparison of cross-legged sitting position with the traditional sitting position for the ease of insertion of an epidural catheter in parturient for providing labour analgesia: a randomised control trial. Indian J Anaesth. 2020; 64: 199-203 Crossref PubMed Scopus (3) Google Scholar