Clinical Results with the Acoustic Puncture Assist Device, a New Acoustic Device to Identify the Epidural Space

Lechner, Tobias; Wijk, Maarten G. van; Maas, Ad J.J.; Dorsten, Frank R. van; Drost, R; Langenberg, C.J.M.; Teunissen, Leo J.; Cornelissen, P.H.J.G.M.; Niekerk, Jan van

doi:10.1213/01.ane.0000052382.04446.42

Cited by 57 publications

(32 citation statements)

References 13 publications

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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%

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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%

“…demonstrated the feasibility of this method in placement of thoracic as well as lumbar epidural catheters. [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.…”

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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“…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: 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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“…It has shown reliable results to detect epidural space in both lumbar and thoracic area. [5678] It provides an objective end point using both visual and auditory senses. Furthermore, it allows the usage of both hands for needle insertion.…”

Section: Introductionmentioning

confidence: 99%

Cervical epidural puncture guided by fluoroscopy in comparison to acoustic signals: Clinical results

2017

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Background and Aim:The increasing cases of the cervical epidural but the practitioners in need for a new method to decrease the safety of the injection and to improve the learning curve of the trainee. Furthermore, it should replace the potentially hazards, conventional one, which is the fluoroscope. Acoustic signals were tested for this purpose.Methods:Thirty-two patients were assigned to have a cervical epidural for pain management using both acoustic signals and fluoroscopy simultaneously.Results:The incidence of success was 100% with no complications. Likewise, the decrease in fluoroscopy shots number was 70%.Conclusions:Acoustic signals are a simple, effective method of cervical epidural insertion. It reduces the usage of fluoroscopy and can be used as a learning tool.

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Clinical Results with the Acoustic Puncture Assist Device, a New Acoustic Device to Identify the Epidural Space

Abstract: The authors demonstrate that it is possible to identify the epidural space by an acoustic and visible signal. An experimental setup constructed for this purpose makes the epidural puncture procedure audible and visible.

Cited by 57 publications

References 13 publications

Localization of epidural space: A review of available technologies

Localization of epidural space: A review of available technologies

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

Cervical epidural puncture guided by fluoroscopy in comparison to acoustic signals: Clinical results

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