Waveform analysis for lumbar epidural needle placement in labour

Sebbag, Ilana; Qasem, F.; Armstrong, Kevin; Jones, Philip M.; Singh, Sudha

doi:10.1111/anae.13540

Cited by 9 publications

(7 citation statements)

References 10 publications

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“…Our results contradict Sebbag et al, who recently reported that epidural pressure waveforms were never demonstrable in the lumbar epidural space in labouring women [14]. We found that a needle positioned in the epidural space displayed a pulsatile waveform in 96% of cases.…”

Section: Discussioncontrasting

confidence: 96%

“…We attribute this discrepancy to the fact that we injected 5 ml of saline through the epidural needle before connecting the extension tubing, in keeping with the recommendation by de M edicis et al [15]. In contrast, Sebbag et al [14] used an unspecified volume of saline for loss-of-resistance, but did not perform the 5-ml saline injection.…”

Section: Discussionmentioning

confidence: 91%

“…However, its usefulness in labouring women remains controversial. Although Ghia et al [12] and De M edicis et al [13] documented pulsatile waveforms in the lumbar epidural space, Sebbag et al [14] reported no pulsatility in the waveform recorded from the epidural needle and catheter in a series of 10 labouring women. These authors hypothesised that differences in the physiology of the pregnant woman may result in increased tissue compliance and decreased arterial pulsation [14].…”

Section: Introductionmentioning

confidence: 98%

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Reliability of pressure waveform analysis to determine correct epidural needle placement in labouring women

et al. 2017

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SummaryPressure waveform analysis provides a reliable confirmatory adjunct to the loss-of-resistance technique to identify the epidural space during thoracic epidural anaesthesia, but its role remains controversial in lumbar epidural analgesia during labour. We performed an observational study in 100 labouring women of the sensitivity and specificity of waveform analysis to determine the correct location of the epidural needle. After obtaining loss-of-resistance, the anaesthetist injected 5 ml saline through the epidural needle (accounting for the volume already used in the loss-ofresistance). Sterile extension tubing, connected to a pressure transducer, was attached to the needle. An investigator determined the presence or absence of a pulsatile waveform, synchronised with the heart rate, on a monitor screen that was not in the view of the anaesthetist or the parturient. A bolus of 4 ml lidocaine 2% with adrenaline 5 lg.ml À1 was administered, and the epidural block was assessed after 15 min. Three women displayed no sensory block at 15 min. The results showed: epidural block present, epidural waveform present 93; epidural block absent, epidural waveform absent 2; epidural block present, epidural waveform absent 4; epidural block absent, epidural waveform present 1. Compared with the use of a local anaesthetic bolus to ascertain the epidural space, the sensitivity, specificity, positive and negative predictive values of waveform analysis were 95.9%, 66.7%, 98.9% and 33.3%, respectively. Epidural waveform analysis provides a simple adjunct to loss-of-resistance for confirming needle placement during performance of obstetric epidurals, however, further studies are required before its routine implementation in clinical practice.

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Section: Discussioncontrasting

confidence: 96%

Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 98%

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Reliability of pressure waveform analysis to determine correct epidural needle placement in labouring women

et al. 2017

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“…Concerning laboring women, using a commercially available transducer for invasive pressure, Sebbag et al 7 observed no epidural pressure waveforms without priming, and they attributed their findings to anatomical and physiological differences in the lumbar epidural space of parturients. On the contrary, Al-Aamri et al 8 who used an invasive blood pressure transducer reported a pulsatile waveform in 96% of cases in laboring women, after priming the epidural space with 5 mL of saline, as suggested by de Medicis et al 9 …”

Section: Discussionmentioning

confidence: 99%

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

Coccoluto¹,

Capogna²,

Camorcia³

et al. 2021

LRA

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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.

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“…Al‐Aamri et al's paper is only the second study to evaluate epidural pressure waveforms in labouring women. Sebbag et al conducted a pilot study of 10 parturients in labour, but were unable to detect any pressure waveforms through the needle or via the epidural catheter, in spite of the epidurals providing adequate analgesia . This equates to 0% sensitivity (95%CI 0–31%), with no failed epidurals to allow a calculation of specificity.…”

Section: Pressure Waveform Analysismentioning

confidence: 99%

Pressure waveforms to assess epidural placement: is there a role on delivery suite?

McKendry

Muchatuta

2017

Anaesthesia

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Waveform analysis for lumbar epidural needle placement in labour

Cited by 9 publications

References 10 publications

Reliability of pressure waveform analysis to determine correct epidural needle placement in labouring women

Reliability of pressure waveform analysis to determine correct epidural needle placement in labouring women

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

Pressure waveforms to assess epidural placement: is there a role on delivery suite?

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