Analysis of Epidural Waveform to Determine Correct Epidural Catheter Placement After CSE Labor Analgesia

Abstract

Background The epidural pressure is pulsatile and synchronized with arterial pulsations. Monitoring the epidural waveform has been suggested as a technique to reliably confirm the appropriate localization of the epidural catheter. Objective The aim of this study was to evaluate the sensitivity and specificity of the Computer Controlled Drug Delivery System with continuous pressure and waveform sensing technology (CCDDS) (CompuFlo ® CathCheck™) as an instrument to assess the correct placement of the catheter in the epidural space in parturients who have received combined spinal-epidural technique (CSE) for labor analgesia. Methods We enrolled 40 consecutive healthy patients undergoing CSE labor analgesia with successful analgesia. All the cases in which pulsatile waveforms in synchrony with heart rate were detected were considered to be true positives; all the cases in which there was the absence of pulsatile waves were followed up. If these patients had to eventually relocate or manipulate the epidural catheter, they were considered to be true negative. If the absence of pulse waves was observed in the presence of successful analgesia during labor, the patients were considered to be false negatives. Results Pulsatile waveforms synchronous with heart rate were observed in 33 cases associated with adequate analgesia. In 5 cases, the pulsatile waveforms were absent due to unilateral analgesia or catheter occlusion (true negatives). In 2 cases, the patients had effective analgesia but we were not able to observe a distinct pulsatile waveform. The pressure waveform analysis through the epidural catheter had a sensitivity of 95%, a positive predictive value of 100%, a specificity of 100% and a negative predictive value of 60%. Conclusion Pulsatile pressure waveform recording with CCDDS through the epidural catheter resulted in high sensitivity and positive predictive value which can help the proper placement of the epidural catheter.

Analgesic Effects, Birth Process, and Prognosis of Pregnant Women in Normal Labor by Epidural Analgesia Using Sufentanil in Combination with Ropivacaine: A Retrospective Cohort Study

“…In China, in order to reduce labor pain, the main measure is to implement epidural painless delivery. According to authoritative data released by the World Health Organization (WHO) in 2010, the cesarean section rate in China is 46.2% (ranking first in the world), which is much higher than the upper limit of WHO cesarean section rate: 15% (of which 11.7% without surgical indication) [ 18 ]. The high rate of cesarean section has become not only a medical problem faced by the medical profession but also a serious “public health problem” faced by our country.…”

Comparison of rostral spread of lumbosacral epidural volume calculated by body weight or length of the vertebral column in dogs

“…Other sophisticated technique includes identifying extradural pressure waves in synchrony with the heart rate, which consists of connecting a sterile, fluid-filled, non-distensible pressure line to a Tuohy needle without stylet and connected to a pressure transducer and multiparametric monitor. The transducer is zeroed at the level of the transverse process of the last lumbar vertebra and the wave scale adjusted to be able to observe positive and pulsatile waves, indicative of the needle being in the epidural space (Adami et al 2013;Coccoluto et al 2021). This technique has 100% specificity and 89% sensitivity; however, the absence of a pressure wave does not have a good negative predictive value (Adami et al 2013).…”