Soft System Based on Fiber Bragg Grating Sensor for Loss of Resistance Detection during Epidural Procedures: In Silico and In Vivo Assessment

Abstract

Epidural analgesia represents a clinical common practice aiming at pain mitigation. This loco-regional technique is widely used in several applications such as labor, surgery and lower back pain. It involves the injections of anesthetics or analgesics into the epidural space (ES). The ES detection is still demanding and is usually performed by the techniques named loss of resistance (LOR). In this study, we propose a novel soft system (SS) based on one fiber Bragg grating sensor (FBG) embedded in a soft polymeric matrix for LOR detection during the epidural puncture. The SS was designed to allow instrumenting the syringe’s plunger without relevant modifications of the anesthetist’s sensations during the procedure. After the metrological characterization of the SS, we assessed the capability of this solution in detecting LOR by carrying it out in silico and in clinical settings. For both trials, results revealed the capability of the proposed solutions in detecting the LOR and then in recording the force exerted on the plunger.

Fiber Optic Distributed Sensing Network for Shape Sensing-Assisted Epidural Needle Guidance

“…Carotenuto et al reported [ 13 ] and tested [ 2 ] a method based on an FBG mounted inside the needle that converts the tip force into a detectable strain. Similar work was recently proposed by De Tommasi et al [ 14 ] using a single FBG assembled in the epidural needle. Ambastha et al [ 15 ] also proposed an FBG-sensing method adapted to lumbar insertion and validated it on an animal model.…”

“…Epidural anesthesia is characterized by a high variability of results, as the layers encountered by the needle as it progresses from the outer skin to the ES vary in thickness and stiffness and, therefore, different patterns are observed [ 14 ]. So far, perceptive methods (loss of resistance, hanging drop) are in use to support clinicians in the task [ 12 ].…”

“…Insertions of the epidural needle through the ES depend on the hand of the operator, the entry angle, and the specific consistency of each tissue, and can result in very different force patterns [ 14 ]. In general, insertions are either characterized by an almost straight pattern, quite insensitive to the sequence of tissues, or by a visible bending of the needle as it crosses the differential of stiffness between interspinous and supraspinous ligaments.…”

Epidural Steroid Injections for Low Back Pain: A Narrative Review

“…The injections are used to deliver steroids, and sometimes local anesthetics, to the epidural space, directly to the site that causes the pain using a caudal, interlaminar or transforaminal approach [ 9 ]. The epidural injection is a well-founded anesthetic and analgesic technique; moreover, nowadays, new technological devices can help anesthesiologists to learn and to administer it [ 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Even though it is still not clear which type of conservative intervention is superior, several studies have proved that an ESI is able to increase patients’ quality of life, relieve lumbosacral radicular pain and finally, reduce or delay more invasive interventions, such as spinal surgery.…”

FBG-Based Soft System for Assisted Epidural Anesthesia: Design Optimization and Clinical Assessment

“…Several researchers promote the introduction of smart devices to support anesthesiologists during the procedure, allowing more accurate detection of the ES and reducing the risk of adverse events caused by a wrong procedure [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. Some of these devices are commercially available and intended to provide visual and/or acoustic feedback to the operator as the ES is reached by measuring pressure during tissue crossing.…”