Clinical results with a new acoustic device to identify the epidural space

Lechner, Tobias; Wijk, M. G. F. van; Maas, Ad J.J.

doi:10.1046/j.1365-2044.2002.02621.x

Cited by 48 publications

(32 citation statements)

References 13 publications

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“…In our study, there were no significant intergroup differences in the efficacy of postoperative pain relief using a continuous infusion of local anaesthetic through the epidural catheter, a fact which corresponds with the findings of other studies in which the efficacy of epidural anaesthesia was 100% in the study group versus 97% in the control group [9,10].…”

Section: Discussionsupporting

confidence: 75%

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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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Section: Discussionsupporting

confidence: 75%

“…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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“…As the loss of resistance is a subjective feeling, higher failure rates occur with inexperienced anesthesiologists [5]. Several attempts have been made to improve or facilitate epidural space detection by the loss of resistance technique by adding a visual or an acoustic signal [2,6,7]. Despite the advantages claimed, none of these techniques have been widely used, probably because they offer no clear additional value or are too cumbersome.…”

Section: Discussionmentioning

confidence: 98%

“…However, a clear loss of resistance cannot be felt in patients with ligamentum flavum weakness [2]. Furthermore, the hanging drop technique might be regarded as an illogical choice for identifying the lumbar epidural space because of the absence of a true negative pressure in this region [3].…”

Section: Introductionmentioning

confidence: 99%

Epidrum®: a new device to identify the epidural space with an epidural Tuohy needle

et al. 2011

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Epidrum(®) is an optimal pressure, loss of resistance device for identifying the epidural space. We investigated the usefulness of Epidrum versus the loss of resistance or hanging drop techniques while performing epidural anesthesia. Eighty adult patients who were scheduled for elective surgery under lumbar epidural anesthesia were randomized into two groups. The first group (Epidrum group) consisted of 40 adult patients who were scheduled for epidural anesthesia using Epidrum. The second group (control group) consisted of 40 adult patients who were scheduled for epidural anesthesia using the loss of resistance or hanging drop technique. We recorded the time required to identify the epidural space and outcomes of epidural catheterization. The attending anesthesiologists were also questioned regarding the ease of control of the Tuohy needle and of epidural space identification with each method. The time required to perform epidural anesthesia was significantly shorter in the Epidrum group than in the control group [28 s (10-76) vs. 90 s (34-185); median (interquartile range)] (p < 0.05). Tuohy needle control was significantly easier in the Epidrum group than in the control group (p < 0.05). Epidrum is useful for performing epidural anesthesia quickly while obtaining good Tuohy needle control.

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“…described an acoustic puncture assist device (APAD) which quantifies the pressure at the epidural needle tip and provides real-time auditory and visual displays of the pressure waveforms, during EDS localization. [6263] Once the needle tip is advanced through the skin, the APAD is connected to the needle hub, which maintains a pressurized fluid column through the epidural needle. As the epidural needle is advanced, the pressure from the column is measured and transmitted as auditory signals and visually displayed as pressure tracings.…”

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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Clinical results with a new acoustic device to identify the epidural space

Cited by 48 publications

References 13 publications

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

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

Epidrum®: a new device to identify the epidural space with an epidural Tuohy needle

Localization of epidural space: A review of available technologies

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