Epidural catheter migration

We read with interest the recent article (Clark et al. Anaesthesia 2001; 56: 865–7). Epidural catheter migration is a well-established problem. It has repercussions that range from inconvenience (to the anaesthetist and the patient) to the problems associated with failure of analgesia. There are numerous catheter fixation techniques to be found in the literature; these include suturing [1], tunnelling [2], adhesive devices and now the Lockit epidural catheter clamp [3]. We, like Clark et al. have found the Lockit fixation device to be very effective at preventing inward and outward migration of epidural catheters. They have however, highlighted the problem of discomfort that was noted in three cases and led to the removal of one epidural in the study. We have found that using the paramedian approach places the Lockit clamp away from the spinous process and thus avoids the discomfort due to the clamp lying on a bony prominence (see Fig. 3). Another problem related to the protuberant nature of the clamp device is that it tends to pierce the dressing thus exposing the epidural catheter. Using the Lyofoam dressings as shown in Fig. 3 provides extra stability and padding to the clamp as well as reducing the risk of catheter damage and exposure.