No abstract

Nowadays, epidural space identification is made by using subjective and manual techniques characterized by failure rates up to 7%. In this work, we propose a fiber optic sensor technology based needle guidance system, that is directly inspired by the most common technique currently used for epidurals; through real-time strain measurements, the fiber Bragg grating integrated inside the needle lumen is able to effectively perceive the typical force drop occurring when the needle enters the epidural space. An in vivo swine study demonstrates the validity of our approach, paving the way for the development of lab-in-aneedle systems.

Placing the needle inside the epidural space for locoregional anesthesia is a challenging procedure, which even today is left to the expertise of the operator. Recently, we have demonstrated that the use of optically sensorized needles significantly improves the effectiveness of this procedure. Here, we propose an optimized configuration, where the optical fiber strain sensor is directly integrated inside the epidural catheter. The new design allows the solving of the biocompatibility issues and increases the versatility of the former configuration. Through an in vivo study carried out on a porcine model, we confirm the reliability of our approach, which also opens the way to catheter monitoring during insertion inside biological spaces.

Introduction: Neuropathic pain can be caused by several pathologies affecting the nervous system. Peripheral neuralgias may be related to nerve entrapment, traumatic or iatrogenic events, and may also accompany many other diseases. Peripheral nerve stimulation is effective in treating many of these neuralgic syndromes. Case Presentation: We treated two patients suffering from chronic neuropathic pain of peripheral origin with the implantation of a Bioness (Valencia CA, USA) StimRouter® peripheral nerve stimulation system with follow-up visits at 1 - 3 - 6 - 12 months. Conclusions: PNS performed with the StimRouter® system, implanted percutaneously under ultrasound guidance, is safe and effective for patients.

This work relies on the development of a sensorized medical needle with an all-optical guidance (Lab in a Needle) system for epidural space identification. The device is based on the judicious integration of a Fiber Bragg grating sensor inside the lumen of an epidural needle to discriminate between different types of tissue and thus providing continuous and real time measurements of the pressure experienced by the needle tip during its advancement. Experiments carried out on an epidural training phantom demonstrate the validity of our approach for the correct and effective identification of the epidural space.