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Minerva Anestesiologica 2020 July;86(7):736-41

DOI: 10.23736/S0375-9393.20.14031-8


lingua: Inglese

A new pressure guided management tool for epidural space detection: feasibility assessment in a clinical scenario

Massimiliano CARASSITI 1 , Rita CATALDO 1, Domenico FORMICA 2, Carlo MASSARONI 3, Aurelio DE FILIPPIS 1, Paola PALERMO 1, Joshua DI TOCCO 3, Roberto SETOLA 4, Chiara VALENTI 1, Emiliano SCHENA 3

1 Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University, Rome, Italy; 2 NEXT Lab, Center for Integrated Research, Campus Bio-Medico University, Rome, Italy; 3 Unit of Measurements and Biomedical Instrumentation, Center for Integrated Research, Campus Bio-Medico University, Rome, Italy; 4 Unit of Automatics and Biomedical Instrumentation, Center for Integrated Research, Campus Bio-Medico University, Rome, Italy

BACKGROUND: The detection of epidural space is usually performed by the technique of loss of resistance (LOR) without technological support, although there are few commercial options. In this work, we aimed to assess the feasibility of a new, non-invasive, mechatronic system for LOR detection in clinical settings. The system allows monitoring the pressure exerted on the syringe plunger by the clinician during the puncture. The LOR is related to the mentioned pressure.
METHODS: Pressure exerted on the syringe plunger by an expert anesthesiologist was monitored using the proposed system. 58 epidural punctures were performed on 34 patients using six configurations with different sensitivities and ranges of measurements. The system capability in LOR detection was evaluated comparing the LOR detected by the system with the feedback provided by the clinician. The procedure time was estimated using the system and without its use.
RESULTS: The detection of LOR is strongly related to the system configuration; it ranged from 93.3% to 27.7%, while 3 configurations never detected it. The procedure time showed a non-significant increase (p=0.56) using the proposed system (average time 71 s vs. 62 s).
CONCLUSIONS: The proposed mechatronic system successfully detected the LOR in the large part of cases using the configurations characterized by the best trade-off between system sensitivity and range of measurements. A non-significant increment of the procedure time is related to the use of the system.

KEY WORDS: Injections, epidural; Anesthesia and analgesia; Equipment and supplies; Pain management

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