The ELDOR Epidural Catheter Has a 3.5 Times Better Sacral Block:

The ELDOR Epidural Catheter (7-holed 20-gauge multiport catheter) has 3.5 times better sacral block (poor sacral block : 6% vs. 21%) than the 3-holed epidural catheters: "more patients in the 7-holed group had adequate sacral analgesia for delivery than in the 3-holed group."

Joseph Eldor, MD



October 15, 2001
2:00:00 PM - 4:00:00 PM
Morial Convention Center, Room C

A Comparison of Three-Holed and Seven-Holed Epidural Catheters in Obstetrics

J. A. Thomas, M.D.; A. W. Smith, M.D.; L. C. Harris, R.N.; P. Rieker, M.D.; R. D'Angelo, M.D.

Dept. of Anesthesiology, Wake Forest Univ. Sch. of Med., Winston-Salem, North Carolina, United States

Introduction: Studies comparing 3-holed epidural catheters to uniport epidural catheters with a distal hole demonstrate that the multiport catheters reduce the incidence of inadequate epidural analgesia and require less manipulation during labor (1-3). These benefits are believed to be from enhanced distribution of local anesthetic through the 3 lateral holes. The hypothesis of the current study is that the additional lateral holes of the 7-holed catheter will further enhance local anesthetic distribution and improve labor analgesia over the 3-holed epidural catheter.
Methods: Following IRB approval, a retrospective chart review was performed on 199 parturients who requested labor analgesia. One hundred women received our standard 3-holed 19-gauge multiport catheter and another 99 received the 7-holed 20-gauge multiport catheter. Both catheter types have closed distal ends and all holes are located within 1.5 cm from the distal tip. All catheters were placed in our customary practice without attempt to control for confounding variables. Data were analyzed using Wilcoxan rank sum, Student's t-test and chi-squared tests as appropriate. P < 0.05 considered significant.
Results: Demographic variables, labor characteristics and mode of delivery were similar between groups. Likewise, analgesia characteristics including verbal pain scores before and after epidural placement, highest sensory block to pinprick and the number of intravenous catheters, unilateral blocks and catheters requiring manipulation or replacement were similar between groups (Table). In contrast, more patients in the 7-holed group had adequate sacral analgesia for delivery than in the 3-holed group.
Conclusions: With the exception of improved sacral analgesia for delivery, the 7-holed epidural catheters did not significantly improve labor analgesia over the 3-holed epidural catheters. Based on the results of this small retrospective review, we conclude that local anesthetic distribution is not significantly enhanced with the 7-holed epidural catheter. Therefore, we can not recommend one epidural catheter over the other.
Table. * Significant difference compared to other group.
1. Anesth Analg 1997;84:1276-9.
2. Anesthesia 1989;44: 578-80.
3. Reg Anesth 1994;48:378-85.

Anesthesiology 2001; 95:A1044



The ELDOR Epidural Catheter Has a Better Flow Rate, Shear Strength and Tensile Strength:


Materials Research Division (Modern Industries, Inc., Erie, Pennsylvania 16512-0399) compared the Eldor epidural catheter (7-holed epidural catheter; CEMLH epidural catheter) to the normal 3 hole catheter.

The O.D. of the 3 hole catheter was 0.87 mm as that of the Eldor epidural catheter. However, the I.D. of the 3 hole catheter was 0.26 mm compared to 0.42 mm of the Eldor catheter.

Testing of the flow rate of the catheters consisted of recording the time for 40 cc of deionized water to flow through the catheters with a 160 kPa pressure head. Flow equilibrium was established prior to actual testing. The flow rate (cc/in) of the 3-hole catheter was 4.05 while that of the Eldor epidural catheter - 5.91.

Testing of the shear strength consisted of recording the transverse load (in kg) to shear the catheters. The shear strength is the load divided by the cross sectional area. The average shear strength (kg/mm2) of the 3-hole catheter was 3.35 compared to 5.91 of the Eldor epidural catheter.

The tensile strength of each catheter was determined by applying an axial load to the catheters and recording the load at time of failure. The tensile strength is the load divided by the original cross sectional area. The tensile strength of the 3-hole catheter was 1.66 kg/mm2 compared to 2.19 kg/mm2.

From the testing performed and the results obtained it can be concluded that the Eldor epidural catheter performed better than the 3-hole catheter in flow rate, shear strength and tensile strength.



The ELDOR Spinal Needle Has a 5 Fold Increase in the Immediate Dispersal Area Compared to the Whitacre Needle:


Dr. Charles H. Ripp ( Springs Pain, Research & Surgery Facility, P.C., Colorado Springs, CO 80907) compared the 26G Eldor spinal needle (DHPP spinal needle) vs. 25G Whitacre needle. The two closed ended spinal injection needles were compared in their ability to have injected solution spread immediately following injection. Each needle was placed in an ice cold H20 bath with the temperature measuring 32 degrees F. Subsequently, 1 cc of 120 degrees F H20 was injected through a 1 cc TB syringe rapidly. Baseline and 1 second post injection infrared images were obtained on an Inframetric System (sensitivity to 0.1 degree F). The temperature of the H20 changed as the injected solution dispersed and was graphically depicted. The green temperature was warmer than the surrounding blue.

The Eldor spinal needle showed a 5 fold increase in the immediate dispersal area compared to the Whitacre needle. The Eldor spinal needle showed greater immediate dispersal of injected solution despite being a smaller gauge. This advantage of the Eldor spinal needle over the Whitacre needle can improve anesthetic spread, provide optimal anesthesia and lessen the risk of local anesthetic toxicity.


The ELDOR Spinal Needle is Stronger than the Gertie Marx Needle:

Gaynes Labs, Incorporated (9708 Industrial Drive, Bridgeview, Illinois 60455) made Axial Compression Tests on the 26G Eldor spinal needle and the 26G Gertie Marx spinal needle. An individual needle, with its stylet in place, was clamped in a holding fixture ( two metal plates with an alignment groove). 3 mm, as measured from the tip of the needle, was exposed outside of the clamp. The end opposite the tip was bent at a 90 degrees angle over the end of the fixture so that the stylet would remain in place. The needle/holding fixture, was then mounted vertically in the jaws of the testing machine with the tip of the needle pointing downward. The jaws were connected to a force measuring device, which was, in turn, connected to the movable ram of the testing machine. The needle advanced downward at a rate of 0.2" per minute, onto a hardened steel block, until the tip of the needle bent to a 90 degrees angle. A data acquisition system recorded the compressive force (in pounds) that was being applied axially to the needle. The maximum compressive force that occurred during the test was recorded.

The maximum force needed to bend the Eldor spinal needle was 9.65 lbs. compared to the maximum force of 9.16 lbs. needed to bend the Gertie Marx needle. Despite the fact that the Eldor needle has two holes at the tip compared to one hole of the Gertie Marx needle the Eldor spinal needle is stronger than the Gertie Marx needle of the same gauge.

The ELDOR Spinal Needle Has a 3.5 Times Better CSF Backflow Than the Pencan Spinal Needle:

Dr. Timo A.R. Palas from the department of Anesthesiology, Regionalspital Biel, 2502 Biel, Switzerland (1997 Annual Meeting of the American Society of Regional Anesthesia, Atlanta Hilton Hotel, Atlanta, Georgia, April 10-13, 1997) compared the 27G Eldor spinal needle to the normal one-hole pencil point 27G spinal needle (Pencan; Braun, Melsungen, Germany). 20 patients were divided into two groups. The lumbar puncture was performed in the sitting position. The holes of the needles pointing upwards. Either plain 2% prilocaine or plain 0.5% bupivacaine was used. The mean age in both groups was 28 years. 4 males and 6 females in each group. The backflow of the cerebrospinal fluid could be seen in a mean time of 0.6 seconds in the Eldor spinal needle compared to 2.1 seconds in the 27G Pencan needle. There were 5 cases of an anesthetic maldistribution in the Pencan group during the first 5 minutes after injection, and none in the Eldor spinal needle group.


The ELDOR Spinal Needle Has 1.8 Times Less Backache Than the Whitacre Spinal Needle:

M. Tryba (Annual ESRA Congress - Nice, France, September 1996) performed a study in patients undergoing spinal anesthesia. The patients were randomly allocated to 25G Whitacre group (n=50) or the 26G Eldor group (n=50). Unlike the Whitacre spinal needle the Eldor spinal needle has two opposite circular holes proximal to the pencil point tip. Each patient received 3 ml isobaric bupivacaine 0.5% at the L3-4 or L4-5 interspace. The extent of anesthesia was similar in both groups. PDPH did not occur in any of the patients. 26% of the patients of the Whitacre group and 14% of the patients of the Eldor group suffered from slight backache.


The ELDOR  Combined Spinal Epidural Needle Allows A Prior Insertion of the Epidural Catheter:

Maurizio Pintore, Fernando Chiumiento, Vincenzo Galdo, Errico Miele and Paolo Paganelli (CAMPANIA REGION A.S.L. Salerno 2 Department of Anaesthesia and Reanimation - Hospital "S. Francesco d’Assisi" OLIVETO CITRA (SA) Italy) Compared the use of the ELDOR Combined Spinal Epidural Needle to the Needle-Through-Needle technique in 107 parturients using combined spinal epidural labor analgesia with fentanyl and bupivacaine. They found that “the needle of ELDOR seems to be a useful technical innovation because it offers a number of advantages:

It makes it possible to position with the required calmness the peridural catheter, without being in a hurry because the subarachnoid block has already been carried out; (hyperbaric solutions > lateral decubitus > analgesia of a hemisoma).

One can avoid the positioning of one needle into another one, which creates the potential risk to put at the internal of the subarachnoid space metallic microcomponents.

It is not possible that the peridural catheter which has been positioned after the aracnoid puncture, can be displaced into the subarachnoid space.

Moreover, the 27 Whitacre needle inserted through the acessory hollow inside the needle of Eldor, is more solid with respect to the needle-in-needle technique, because the little movements during the injection are avoided, which at times are the cause of displacement of the needle in the subaracnoid space causing a failure of the block.

When the puncture of the arachnoid proceeds the insertion of the catheter, it happens often that from this catheter leaks liquor that can lead to a wrong diagnoses of a subarachnoid displacement of the catheter. “





A comparison between two types of spinal needle, Quinke and Eldor at KMCTH and Narayani Subregional Hospital, Nepal for elective c/s. Insertion characteristic and Complications


Dr. Sushila Tabdar(1), Dr. Babu Raja Shrestha (1),Dr. Shyam K. Maharjan (1) and Dr. Jagadish Agrawal (2) Dr. B. M. Shrestha (3)

(1) Lecturer, (3) Prof., Department of Anaesthesiology

Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu.

(2) Consultant Anesthesiologist

Narayani Subregional Hospital, Birganj.




Purpose:  To study frequency of postdural puncture headache (PDPH) with the use of 25-G Quincke spinal needles and 26-G Eldor spinal needles.


Methods: One hundred and sixty women undergoing Caesarean section under spinal anaesthesia were allocated randomly to have a 25-gauge Quincke needle or 26-gauge Eldor needle inserted into the lumbar subarachnoid space. Ninety women had insertion of quinke needle and seventy had Eldor spinal needle. Quincke spinal needle is commonly available in Nepal. Pencil point needle is not available. We received Eldor (pencil point double hole) Spinal needle as donation.


The groups were compared for ease of insertion, number of attempted needle insertions before identification of cerebrospinal fluid, quality of subsequent analgesia, failure of the procedure and incidence of postoperative complications.



The difficulty was experienced in insertion of Eldor spinal needle only in first few cases and multiple attempts has to be done. The back flow of CSF from Eldor spinal needle was quicker and quality of subsequent analgesia was better. There was no failure in the procedure. Postdural puncture headache (PDPH) was experienced by 10 mothers in the 25-gauge Quincke group and none in Eldor group. Three of the 10 PDPH occurred after a single successful needle insertion. Seven had more than two needle insertions. Two cases of PDPH had to be managed by blood patch. Post operative back ache was complained by twenty of them and all of them had multiple insertion of spinal needle.


Conclusion: We conclude that the use of 25-gauge Quincke needles in Caesarean section patients is associated with incidence of PDPH. There was no incidence of PDPH with Eldor spinal needles. There was no bloody tap and no failure.