Identification of the Epidural Space Using Pressure Measurement With the Compuflo Injection Pump – A Pilot Study

Ghelber, Oscar; Gebhard, Ralf E.; Vora, Sejal; Hagberg, Carin A.; Szmuk, Peter

doi:10.1016/j.rapm.2008.01.012

Cited by 20 publications

(11 citation statements)

References 10 publications

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“…[626364] Ghelber et al . [65] described a similar technique using a computer controlled injection pump to objectively measure the drop in pressure encountered on entering EDS. As the anesthesiologist advances the epidural needle, entry into EDS is identified based on visual display of the pressure waveform.…”

Section: Discussionmentioning

confidence: 99%

Localization of epidural space: A review of available technologies

Elsharkawy

Sonny

Chin

2017

J Anaesthesiol Clin Pharmacol

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Although epidural analgesia is widely used for pain relief, it is associated with a significant failure rate. Loss of resistance technique, tactile feedback from the needle, and surface landmarks are traditionally used to guide the epidural needle tip into the epidural space (EDS). The aim of this narrative review is to critically appraise new and emerging technologies for identification of EDS and their potential role in the future. The PubMed, Cochrane Central Register of Controlled Clinical Studies, and Web of Science databases were searched using predecided search strategies, yielding 1048 results. After careful review of abstracts and full texts, 42 articles were selected to be included. Newer techniques for localization of EDS can be broadly classified into techniques that (1) guide the needle to the EDS, (2) identify needle entry into the EDS, and (3) confirm catheter location in EDS. An ideal method should be easy to learn and perform, easily reproducible with high sensitivity and specificity, identifies inadvertent intrathecal and intravascular catheter placements with ease, feasible in perioperative setting and have a cost-benefit advantage. Though none of them in their current stages of development qualify as an ideal method, many show tremendous potential. Some techniques are useful in patients with difficult spinal anatomy and infants, and thus are complementary to traditional methods. In addition to improving the existing technology, future research should aim at proving the superiority of these techniques over traditional methods, specifically regarding successful EDS localization, better safety profile, and a favorable cost-benefit ratio.

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Section: Discussionmentioning

confidence: 99%

Localization of epidural space: A review of available technologies

Elsharkawy

Sonny

Chin

2017

J Anaesthesiol Clin Pharmacol

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“…59 A pilot study found fewer epidural catheter failures when the Episure Autodetect syringe was used for the placement compared to a glass syringe. 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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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Background Neuraxial anesthesia and epidural steroid injection techniques require precise anatomical targeting to ensure successful and safe analgesia. Previous studies suggest that only some of the tissues encountered during these procedures can be identified by spectroscopic methods, and no previous study has investigated the use of Raman, diffuse reflectance, and fluorescence spectroscopies. The authors hypothesized that real-time needle-tip spectroscopy may aid epidural needle placement and tested the ability of spectroscopy to distinguish each of the tissues in the path of neuraxial needles. Methods For comparison of detection methods, the spectra of individual, dissected ex vivo paravertebral and neuraxial porcine tissues were collected using Raman spectroscopy (RS), diffuse reflectance spectroscopy, and fluorescence spectroscopy. Real-time spectral guidance was tested using a 2-mm inner-diameter fiber-optic probe-in-needle device. Raman spectra were collected during the needle’s passage through intact paravertebral and neuraxial porcine tissue and analyzed afterward. The RS tissue signatures were verified as mapping to individual tissue layers using histochemical staining and widefield microscopy. Results RS revealed a unique spectrum for all ex vivo paravertebral and neuraxial tissue layers; diffuse reflectance spectroscopy and fluorescence spectroscopy were not distinct for all tissues. Moreover, when accounting for the expected order of tissues, real-time Raman spectra recorded during needle insertion also permitted identification of each paravertebral and neuraxial porcine tissue. Conclusions This study demonstrates that RS can distinguish the tissues encountered during epidural needle insertion. This technology may prove useful during needle placement by providing evidence of its anatomical localization.

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“…Since traditional identification is performed blindly, research has been carried out to find new methods of facilitating ES identification [5,9].…”

Section: Discussionmentioning

confidence: 99%

Porównanie techniki identyfikacji przestrzeni zewnątrzoponowej przy użyciu strzykawki niskooporowej i automatycznej — wyniki badania z randomizacją i ślepą próbą

Duniec

Nowakowski²,

Sieczko³

et al. 2016

Anaesthesiol Intensive Ther

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Background: The conventional, loss of resistance technique for identification of the epidural space is highly dependent on the anaesthetist's personal experience and is susceptible to technical errors. Therefore, an alternative, automated technique was devised to overcome the drawbacks of the traditional method. The aim of the study was to compare the efficacy of epidural space identification and the complication rate between the two groups -the automatic syringe and conventional loss of resistance methods. Methods: 47 patients scheduled for orthopaedic and gynaecology procedures under epidural anaesthesia were enrolled into the study. The number of attempts, ease of epidural space identification, complication rate and the patients' acceptance regarding the two techniques were evaluated. Results: The majority of blocks were performed by trainee anaesthetists (91.5%). No statistical difference was found between the number of needle insertion attempts (1 vs. 2), the efficacy of epidural anaesthesia or the number of complications between the groups. The ease of epidural space identification, as assessed by an anaesthetist, was significantly better (P = 0.011) in the automated group (87.5% vs. 52.4%). A similar number of patients (92% vs. 94%) in both groups stated they would accept epidural anaesthesia in the future. Conclusion:The automated and loss of resistance methods of epidural space identification were proved to be equivalent in terms of efficacy and safety. Since the use of the automated technique may facilitate epidural space identification, it may be regarded as useful technique for anaesthetists inexperienced in epidural anaesthesia, or for trainees.

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Identification of the Epidural Space Using Pressure Measurement With the Compuflo Injection Pump – A Pilot Study

Abstract: This investigation demonstrates that a computerized injection pump can be used to identify the epidural space and can serve as a base for further comparative research to determine whether this technology can increase the success rate of EA or lower the incidence of side effects.

Cited by 20 publications

References 10 publications

Localization of epidural space: A review of available technologies

Localization of epidural space: A review of available technologies

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

Porównanie techniki identyfikacji przestrzeni zewnątrzoponowej przy użyciu strzykawki niskooporowej i automatycznej — wyniki badania z randomizacją i ślepą próbą

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