Comparative study of Episure™ AutoDetect™ syringe versus glass syringe for identification of epidural space in lower thoracic epidural

Abstract

Background and Aims:Episure™ AutoDetect™ syringe (EAS), a spring-loaded syringe, is a new loss-of-resistance syringe used to identify epidural space. It has an advantage of subjective and objective confirmation in identifying epidural space over glass syringe (GS) for beginners. We compared the performance of EAS with that of GS for identifying epidural space in lower thoracic epidurals.Methods:A total of 120 American Society of Anesthesiolgists I-II patients aged 18–60 years requiring lower thoracic epidural analgesia for surgery were randomised into Group I (EAS): Epidural identified using EAS and Group II (GS) epidural identified with GS. Patient demographic data, depth to epidural space (cm), number of attempts, time to locate epidural space (s), inadvertent dural puncture and failed epidural analgesia were the parameters noted.Results:There were no differences in patient demographics or depth to the epidural space between the two groups. There were five failed blocks in the GS group and none in the EAS group (P = 0.0287). Similarly, there were five inadvertent dural punctures in the GS group and none in the EAS group (P = 0.0287). When epidural was identified in fewer attempts, the time needed to identify epidural space was quicker with EAS (P = 0.0012).Conclusion:Using EAS allowed reliable and quick identification of the epidural space in lower thoracic epidural technique as compared to use of glass syringe. There was no incidence of inadvertent dural puncture or failed blocks with the EAS.

Randomized comparison of two methods of the epidural space identification during regional labour analgesia

“…Epimatic® is a low-resistance syringe where continuous positive pressure on the plunger is achieved by an elastic strip. When the Tuohy needle enters the epidural space, LOR is visible by the sudden movement of the syringe plunger, which removes operator subjectivity and variability [14]. The other advantage of the spring-loaded syringe is that both hands can be used for needle's advance and stabilization [15].…”

“…There was one accidental dural puncture in the control group [19]. The literature offers reports on 3 other syringes with a similar mechanism of action (constant positive-pressure for the automated EPD identification), namely (i) Episure™ AutoDetect™ syringe, Indigo Orb, Inc., Santa Clara, California, United States [14,15,[20][21][22] (ii) Epidrum, Emooor Innovations Ltd. Taunton, United Kingdom [13,[22][23][24][25][26][27][28] and (iii) Epi-Jet, Egemen International, Izmir, Turkey [13,29].…”

“…Our study found no difference for the primary outcome, namely the efficacy of EDA measured by NRS. In the literature, the failed analgesia was defined in the study by Habib [21] and Joseph [14] as a need to resit needle due to the failure to obtain sensory blockade after the initial drug dosage and occurred significantly less often in the the Episure™ group compared to controls (0% vs. 3.2%; 0% vs.8.3% respectively). However, findings from Deighan et al [23] on Epidrum reports on the higher rate of failed analgesia (6% vs. 0%).…”

A New Pressure Guided Management Tool for Epidural Space Detection: Feasibility Assessment on a Simulator

“…Basically, it consists of a syringe embedding a coaxial compression; the plunger automatically depresses when the needle enters epidural space, providing a visual confirmation of LOR. This system has been validated in clinical settings with promising results: in a pilot study performed in 168 parturients there was no failure during the epidural blockade .…”

“…Recent studies have shown the introduction of new techniques aiming to have an objective detection of the LOR, and, in many cases, these investigations have led to commercial devices .…”