{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T11:20:57Z","timestamp":1783164057677,"version":"3.54.6"},"reference-count":22,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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&amp;lt;0.05). Consequently, the novel technique significantly extended mean functional catheter duration (7.6 days [CI 3.9\u201311.3] vs. 4.2 days [CI 2.8\u20135.6]; 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag307","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T11:46:01Z","timestamp":1781783161000},"source":"Crossref","is-referenced-by-count":0,"title":["Impact of Intradermal Fixation on Epidural Catheter Durability and Dislodgement Rates"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2960-1806","authenticated-orcid":false,"given":"Myroslav","family":"Stupnytskyi","sequence":"first","affiliation":[{"name":"Department of Neuroanesthesiology and Critical Care in the Neurosurgery and Neurology Clinic, Military Medical Clinical Centre of the Western Region , Lviv 79010,","place":["Ukraine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8695-956X","authenticated-orcid":false,"given":"Andrii","family":"Rodzonyak","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care in the Cardiovascular Surgery Clinic, Military Medical Clinical Centre of the Western Region , Lviv 79010,","place":["Ukraine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8271-5324","authenticated-orcid":false,"given":"Victoria","family":"Lys","sequence":"additional","affiliation":[{"name":"Department of Postgraduate Education, Danylo Halytsky Lviv National Medical University , Lviv 79010,","place":["Ukraine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"2026070406494932400_usag307-B1","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1097\/j.pain.0000000000003094","article-title":"A systematic review of the prevalence of postamputation and chronic neuropathic pain associated with combat injury in military personnel","volume":"165","author":"Kumar","year":"2024","journal-title":"Pain"},{"key":"2026070406494932400_usag307-B2","doi-asserted-by":"publisher","first-page":"1285","DOI":"10.1016\/j.bja.2024.02.019","article-title":"Pain after \u00adcombat injury in male UK military personnel deployed to Afghanistan","volume":"132","author":"Vollert","year":"2024","journal-title":"Br J Anaesth"},{"key":"2026070406494932400_usag307-B3","first-page":"360","article-title":"Efficacy of bupivacaine and ropivacaine for postoperative analgesia in continuous epidural infusion in lower limb surgeries under combined spinal-epidural analgesia","volume":"21","author":"Meghana","year":"2017","journal-title":"Anaesth Pain & Intensive Care"},{"key":"2026070406494932400_usag307-B4","doi-asserted-by":"publisher","first-page":"86","DOI":"10.55302\/MJA2484086ch","article-title":"Unveiling the advantages: reduced opioid requirement with continuous epidural analgesia\u2014pilot study","volume":"8","author":"Chavkoska","year":"2024","journal-title":"MJA"},{"key":"2026070406494932400_usag307-B5","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1097\/ALN.0000000000001521","article-title":"Practice advisory for the prevention, diagnosis, and management of infectious complications associated with neuraxial techniques: an updated report by the American Society of Anesthesiologists Task Force on infectious complications associated with neuraxi","volume":"126","year":"2017","journal-title":"Anesthesiology"},{"key":"2026070406494932400_usag307-B6","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1034\/j.1399-6576.2003.00118.x","article-title":"Catheter-related epidural abscesses\u2014don\u2019t wait for neurological deficits","volume":"47","author":"Royakkers","year":"2003","journal-title":"Acta Anaesthesiol Scand"},{"key":"2026070406494932400_usag307-B7","author":"Huh","year":"2020"},{"key":"2026070406494932400_usag307-B8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2014\/610635","article-title":"Tunneling and suture of thoracic epidural catheters decrease the incidence of catheter dislodgement","volume":"2014","author":"Sellmann","year":"2014","journal-title":"Sci World J"},{"key":"2026070406494932400_usag307-B9","doi-asserted-by":"publisher","first-page":"1144","DOI":"10.1111\/j.1399-6576.2008.01712.x","article-title":"Nosocomial infections and infection control in regional anesthesia","volume":"52","author":"Schulz-St\u00fcbner","year":"2008","journal-title":"Acta Anaesthesiol Scand"},{"key":"2026070406494932400_usag307-B10","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1111\/aas.12649","article-title":"Fluoroscopy-assisted epidural catheter placement: an exploratory analysis of 303 pre-operative epidurograms","volume":"60","author":"Yeager","year":"2016","journal-title":"Acta Anaesthesiol Scand"},{"key":"2026070406494932400_usag307-B11","doi-asserted-by":"publisher","first-page":"930","DOI":"10.4103\/aer.AER_159_18","article-title":"Tunneling does not prevent dislodgment of epidural catheters: a randomized trial","volume":"12","author":"Abukhudair","year":"2018","journal-title":"Anesth Essays Res"},{"key":"2026070406494932400_usag307-B12","doi-asserted-by":"publisher","first-page":"203","DOI":"10.54875\/jarss.2023.59480","article-title":"Comparison of epidural catheter migration in three different techniques of catheter fixation: a prospective randomised study","volume":"31","author":"Viburajah","year":"2023","journal-title":"JARSS"},{"key":"2026070406494932400_usag307-B13","doi-asserted-by":"publisher","first-page":"514","DOI":"10.4103\/sja.sja_156_22","article-title":"Subcutaneous tunneling of epidural catheter in four easy steps\u2014A novel technique","volume":"16","author":"Khan","year":"2022","journal-title":"Saudi J Anaesth"},{"key":"2026070406494932400_usag307-B14","doi-asserted-by":"publisher","first-page":"65","DOI":"10.4103\/0970-9185.175667","article-title":"Epidural catheter fixation. A comparison of subcutaneous tunneling versus device fixation technique","volume":"32","author":"Sharma","year":"2016","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"2026070406494932400_usag307-B15","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1046\/j.1365-2044.2000.01645.x","article-title":"Tunnelling epidural catheters: a worthwhile exercise?: editorial","volume":"55","author":"Kumar","year":"2000","journal-title":"Anaesthesia"},{"key":"2026070406494932400_usag307-B16","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1093\/bja\/aew026","article-title":"Tunnelling of thoracic epidural catheters is associated with fewer catheter-related infections: a retrospective registry analysis","volume":"116","author":"Bomberg","year":"2016","journal-title":"Br J Anaesth"},{"key":"2026070406494932400_usag307-B17","doi-asserted-by":"publisher","first-page":"94157","DOI":"10.5492\/wjccm.v13.i3.94157","article-title":"Why do thoracic epidurals fail? A literature review on thoracic epidural failure and catheter confirmation","volume":"13","author":"Kumar","year":"2024","journal-title":"World J Crit Care Med"},{"key":"2026070406494932400_usag307-B18","doi-asserted-by":"publisher","first-page":"59","DOI":"10.4097\/kja.20131","article-title":"Prevention of epidural catheter migration: a comparative evaluation of two tunneling techniques","volume":"74","author":"Gautam","year":"2021","journal-title":"Korean J Anesthesiol"},{"key":"2026070406494932400_usag307-B19","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.jclinane.2016.10.013","article-title":"Partial displacement of epidural catheter after patient position change: a case report","volume":"37","author":"Shon","year":"2017","journal-title":"J Clin Anesth"},{"key":"2026070406494932400_usag307-B20","doi-asserted-by":"publisher","first-page":"109955","DOI":"10.1016\/j.jclinane.2020.109955","article-title":"Factors associated with complete outward migration of postoperative epidural analgesia catheters placed for oncologic surgery: a 10-year single-center retrospective study","volume":"66","author":"Su","year":"2020","journal-title":"J Clin Anesth"},{"key":"2026070406494932400_usag307-B21","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1111\/anae.13351","article-title":"Intrapartum epidural fixation methods: a randomised controlled trial of three \u00addifferent epidural catheter securement devices","volume":"71","author":"Odor","year":"2016","journal-title":"Anaesthesia"},{"key":"2026070406494932400_usag307-B22","doi-asserted-by":"publisher","first-page":"768","DOI":"10.1007\/s12630-019-01554-x","article-title":"Regional anesthesia catheter tunnelling: a simpler approach","volume":"67","author":"Maguire","year":"2020","journal-title":"Can J Anaesth"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag307\/68696214\/usag307.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag307\/68696214\/usag307.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T10:50:13Z","timestamp":1783162213000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article\/doi\/10.1093\/milmed\/usag307\/8724777"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,3]]},"references-count":22,"URL":"https:\/\/doi.org\/10.1093\/milmed\/usag307","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,3]]},"article-number":"usag307"}}