Randomized comparison of two methods of the epidural space identification during regional labour analgesia
Abstract
Objectives: Conventional loss of resistance (LOR) technique for identifying the epidural space (EDS) predominantly depends on experience of the anaesthetist. A technique using automated syringe for EDS identification was invented as an alternative to the traditional method. The aim of the study was to compare the efficacy and risk for complications between automatic LOR syringe — Epimatic® (Vygon, Ecouen, France) and conventional LOR — Perifix® (B.Braun Melsungen AG, Melsungen, Germany) techniques for EDS identification.
Material and methods: A total of 170 patients were enrolled into the study and 153 cases were analysed. Number of at- tempts, time to EDS identification, ease of EDS identification, complication rate and patient procedure-related discomfort were evaluated and compared.
Results: No statistically significant differences were found in the number of needle insertion attempts (1.3 in both groups), time to EDS identification (31 sec. vs. 27 sec.), efficacy of epidural analgesia (100% in both groups), or complication rate between both groups.
Conclusions: The automatic and the conventional LOR techniques are comparable in terms of efficacy and safety for the epidural space identification.
Keywords: epidural analgesiaepidural spaceloss-of-resistance techniqueautomatic identificationlabour analgesia
References
- Cambic CR, Wong CA. Labour analgesia and obstetric outcomes. Br J Anaesth. 2010; 105 Suppl 1: i50–i60.
- Rafii-Tari H, Lessoway VA, Kamani AA, et al. Panorama Ultrasound for Navigation and Guidance of Epidural Anesthesia. Ultrasound Med Biol. 2015; 41(8): 2220–2231.
- Hughes SC, Levinson G, Rosen MA, Shnider SM. Shnider and Levinson’s anesthesia for obstetrics - Maternal Physiologic Alterations during pregnancy. Lippincott Williams & Wilkins 2002.
- Kaur K, Singhal S, Bala M. Identification of epidural space using loss of resistance syringe, infusion drip, and balloon technique: A comparative study. Saudi Journal of Anaesthesia. 2014; 8(5): 41.
- Fyneface-Ogan S. Anatomy and Clinical Importance of the Epidural Space. In: Epidural Analgesia - Current Views and Approaches. InTechOpen 2012.
- Jacob S, Tierney E. A dual technique for identification of the epidural space. Anaesthesia. 1997; 52(2): 141–143.
- Teng WN, Tsou MY, Chang WK, et al. Eyes on the needle: Identification and confirmation of the epidural space. Asian J Anesthesiol. 2017; 55(2): 30–34.
- Lechner TJM, van Wijk MGF, Maas AJJ. Clinical results with a new acoustic device to identify the epidural space. Anaesthesia. 2002; 57(8): 768–772.
- Elsharkawy H, Sonny A, Chin KiJ. Localization of epidural space: A review of available technologies. J Anaesthesiol Clin Pharmacol. 2017; 33(1): 16–27.
- Samhan YM, El-Sabae HH, Khafagy HF, et al. A pilot study to compare epidural identification and catheterization using a saline-filled syringe versus a continuous hydrostatic pressure system. J Anesth. 2013; 27(4): 607–610.
- Antibas PL, do Nascimento Junior P, Braz LG, et al. Air versus saline in the loss of resistance technique for identification of the epidural space. Cochrane Database Syst Rev. 2014(7): CD008938.
- Schröder G, Kundt G, Otte M, et al. Impact of pregnancy on back pain and body posture in women. J Phys Ther Sci. 2016; 28(4): 1199–1207.
- Kartal S, et al. Comparison of Epidrum, Epi-Jet, and Loss of Resistance syringe techniques for identifying the epidural space in obstetric patients. Niger. J. Clin. Pract. 2017; 20(8): 992–997.
- Joseph EJ, Pachaimuthu E, Arokyamuthu V, et al. Comparative study of Episure™ AutoDetect™ syringe versus glass syringe for identification of epidural space in lower thoracic epidural. Indian J Anaesth. 2015; 59(7): 406–410.
- Riley ET, Carvalho B. The Episure syringe: a novel loss of resistance syringe for locating the epidural space. Anesth Analg. 2007; 105(4): 1164–6, table of contents.
- Moher D, et al. CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomised trials. J. Clin. Epidemiol. 2010; 63(8): e1–e37.
- Zelterman L, Louis T. Medical uses of statistics - Contingency tables in medical studies, 3rd ed. John Wiley & Sons 2009.
- Jones AM. Applied econometrics for health economists: a practical guide.
- G D, K M, R J. COMPARISON OF TECHNIQUES- IDENTIFICATION OF EPIDURAL SPACE USING THE LOSS OF RESISTANCE SYRINGE AND AN AUTOMATED SYRINGE. Journal of Evolution of Medical and Dental Sciences. 2017; 6(80): 5657–5660.
- Carabuena J, Mitani A, Liu X, et al. The Learning Curve Associated with the Epidural Technique Using the Episure™ AutoDetect™ Versus Conventional Glass Syringe. Anesthesia & Analgesia. 2013; 116(1): 145–154.
- Habib AS, George RB, Allen TK, et al. A Pilot Study to Compare the EpisureTM AutodetectTM Syringe with the Glass Syringe for Identification of the Epidural Space in Parturients. Anesth. Analg. 2008; 106(2): 541–543.
- Paech MJ, Muchatuta NA, Griffiths JD, et al. The Episure loss-of-resistance syringe. Anaesth Intensive Care. 2011; 39(5): 976.
- Deighan M, Briain DO, Shakeban H, et al. A randomised controlled trial using the Epidrum for labour epidurals. Ir Med J. 2015; 108(3): 73–75.
- Hirabayashi T, et al. Usefulness of Epidrum for teaching identification of the epidural space. Masui. 2011; 60(9): 1078–1081.
- Kim SW, Kim YMi, Kim SH, et al. Comparison of loss of resistance technique between Epidrum® and conventional method for identifying the epidural space. Korean J Anesthesiol. 2012; 62(4): 322–326.
- Le Guen M, Charvet A, Leone M, et al. Epidrum is an unreliable device for identifying the thoracic epidural space. Eur J Anaesthesiol. 2018; 35(9): 716–717.
- Sawada A, Kii N, Yoshikawa Y, et al. Epidrum(®): a new device to identify the epidural space with an epidural Tuohy needle. J Anesth. 2012; 26(2): 292–295.
- Seog Sim W, et al. False Loss of Resistance in Cervical Epidural Injection: The Loss of Resistance Technique Compared with the Epidrum Guidance in Locating Epidural Space. Pain Physician. 2016; 19: 131–138.
- Demırel A, et al. The Comparison of Loss of Resistance Technique, Automatic Loss of Resistance Syringe and Hanging Drop Technique for Identifying Epidural Space. Int. J. Pain Reli. 2017; 1(1): 32–35.
- Grau T, Leipold RW, Horter J, et al. The lumbar epidural space in pregnancy: visualization by ultrasonography. Br J Anaesth. 2001; 86(6): 798–804.
