Comparison of loss of resistance technique between Epidrum® and conventional method for identifying the epidural space

Abstract

BackgroundEpidrum® is a recently developed, air operated, loss of resistance (LOR) device for identifying the epidural space. We investigated the usefulness of Epidrum® by comparing it with the conventional LOR technique for identifying the epidural space.MethodsOne hundred eight American Society of Anesthesiologists (ASA) physical status I or II patients between the ages of 17 and 68 years old and who were scheduled for elective surgery under combined spinal-epidural anesthesia were enrolled in this study. The patients were randomized into two groups: one group received epidural anesthesia by the conventional LOR technique (C group) and the second group received epidural anesthesia using Epidrum® (ED group). While performing epidural anesthesia, the values of variables were recorded, including the number of failures, more than 2 attempts, the incidence of dural puncture, the time needed to locate the epidural space, the distance from the skin to the epidural space and ease of performance, and the satisfaction scores.ResultsThe ED group showed a lower failure rate, fewer cases of more than 2 attempts, a lesser time to identify the epidural space, and better ease and satisfaction scores of procedure than the C group, with statistical significance.ConclusionsUsing Epidrum® compared to the conventional LOR technique is an easy, rapid, and reliable method for identifying the epidural space.

Commonly-used versus less commonly-used methods in the loss of resistance technique for identification of the epidural space: A systematic review and meta-analysis of randomized controlled trials

“…Fourteen studies were excluded, as they were reviews, letters to the editor, or did not address one or more aspects of the research question. A total of eight studies [20,28,[46][47][48][49][50][51] with a total of 1583 participants were deemed eligible for inclusion. No additional eligible studies were identified based on hand-searching of major anesthesia journals or manual review of reference lists of relevant primary studies and systematic reviews ( Fig.…”

“…Table 2 describes study characteristics regarding setting, number of participants, mean age, gender, eligibility criteria, and follow-up. All included studies [20,28,[46][47][48][49][50][51] were parallel trials. Three studies [20,47, 48] were conducted largely in Asia (one in Korea, and two in Japan), one in Ireland [46], one in Egypt [50], one in Canada [51], and one in Nigeria [49].…”

“…Table 3 describes study characteristics related to intervention and comparator groups, and assessed outcomes. Of the eight RCTs, three compared epidrum to air [20,46,47]; two compared epidrum to saline [47,48]; one compared modified Macintosh epidural balloon to air [49]; one compared acoustic device to air; one compared lidocaine 2% to air [28]; one compared lidocaine 1.5% to air or saline [51]; and one compared the acoustic device to air [50] (Table 3). Fig.…”

“…2 and Table 4 describe the risk of bias assessment for the RCTs. Allocation concealment was a major risk of bias limitation across all eligible RCTs [20,28,[46][47][48][49][50][51]. Other issues with risk of bias among eligible RCTs were random sequence generation [20,28,[47][48][49][50][51], lack of blinding of participants, caregivers, data collectors, and statisticians [20,28,[47][48][49]51], and lack of blinding of outcome assessors [20,[47][48][49]51].…”

Raman Spectroscopy Differentiates Each Tissue from the Skin to the Spinal Cord

“…12 Similarly, use of the Epidrum device led to a lower epidural failure rate and less time to identify epidural space compared to use of the traditional loss of resistance syringe. 13 …”