Pressure waveform-guided epidural catheter placement in comparison to the loss-of-resistance conventional method

Gong, Yuhua; Shi, Haixia; Wu, Jie; Labu, Danbaila; Sun, Junzhi; Zhong, Hongmei; Li, Libiao; Xin, Xuedong; Wu, Lifang; Ma, Ding

doi:10.1016/j.jclinane.2014.01.015

Cited by 19 publications

(8 citation statements)

References 18 publications

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“…This has prompted some authors to forego LOR and to connect a pressure transducer to the epidural needle during its advancement in ligamentum flavum. 53 As soon as the needle tip enters the epidural space, the pressure suddenly decreases, and the pressure tracing becomes synchronized with arterial pulsations (Fig. 2).…”

Section: Epidural Waveform Analysismentioning

confidence: 99%

Confirmation of Loss-of-Resistance for Epidural Analgesia

Tran

González

Bernucci

et al. 2015

Regional Anesthesia and Pain Medicine

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Section: Epidural Waveform Analysismentioning

confidence: 99%

Confirmation of Loss-of-Resistance for Epidural Analgesia

Tran

González

Bernucci

et al. 2015

Regional Anesthesia and Pain Medicine

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“…[17][18][19] Moreover, large audits indiscriminately combine thoracic and lumbar epidural analgesia. [20][21][22] Definition of success/failure can also be misleading. In a large study (n = 7548 thoracic epidural blocks), Tanaka et al 23 reported a 2.5% primary failure rate.…”

Section: Primary Failure Of Tea In Training Centersmentioning

confidence: 99%

Primary Failure of Thoracic Epidural Analgesia in Training Centers

Tran

Zundert

Aliste

et al. 2016

Regional Anesthesia and Pain Medicine

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In teaching centers, primary failure of thoracic epidural analgesia can be due to multiple etiologies. In addition to the difficult anatomy of the thoracic spine, the conventional end point-loss-of-resistance-lacks specificity. Furthermore, insufficient training compounds the problem: learning curves are nonexistent, pedagogical requirements are often inadequate, supervisors may be inexperienced, and exposure during residency is decreasing. Any viable solution needs to be multifaceted. Learning curves should be explored to determine the minimal number of blocks required for proficiency. The problem of decreasing caseload can be tackled with epidural simulators to supplement in vivo learning. From a technical standpoint, fluoroscopy and ultrasonography could be used to navigate the complex anatomy of the thoracic spine. Finally, correct identification of the thoracic epidural space should be confirmed with objective, real-time modalities such as neurostimulation and waveform analysis.

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“…Epidural analgesia is highly effective for labour pain relief, but can be challenging to perform in labouring patients . The ability to transduce a pulsatile pressure waveform from epidural needles in non‐pregnant patients correlates with successful epidural blockade . We have evaluated the feasibility of transducing an epidural waveform in labouring women.…”

mentioning

confidence: 99%