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

This study was carried out on one hundred and fifty male patients undergoing TURP and Cystoscopy under lumbar epidural anaesthesia in urology department mayo hospital with age between 30 years to 100 years with mean 64.29 years, weight 37kg to 96kg with mean 59.21kg and height between 140cm to 187cm with mean 165.34cm. All patients were administered single shot-lumbar epidural anesthesia with tuohy needle no 16 with bupivacain 0.5% volume ranging 15cc to 20cc at level of L3-4 or L4-5 level. Two patients developed lumbar puncture and managed conservatively. The lumbar epidural space ranged between 3.5cm to 6.5cm with mean depth 4.38Â±0.563. It was concluded statistically that lumbar epidural space depth had better relation to the weight of patients than height.

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The Fiberscopic Findings of the Epidural Space in Pregnant Women

Anesthesiology ◽

10.1097/00000542-200006000-00021 ◽

2000 ◽

Vol 92 (6) ◽

pp. 1631-1636 ◽

Cited By ~ 42

Author(s):

Takashi Igarashi ◽

Yoshihiro Hirabayashi ◽

Reiju Shimizu ◽

Kazuhiko Saitoh ◽

Hirokazu Fukuda ◽

...

Keyword(s):

Epidural Analgesia ◽

Pregnant Women ◽

Blood Vessels ◽

Epidural Space ◽

First Trimester ◽

Tuohy Needle ◽

Vascular Networks ◽

Third Trimester ◽

The Third ◽

Spread Of Epidural Analgesia

Background The spread of epidural analgesia is facilitated by pregnancy. Changes in the epidural structure during pregnancy may affect the spread of analgesia in pregnant women. To investigate the changes in the epidural space produced by pregnancy, the authors performed epiduroscopy in pregnant women. Methods Using a flexible fiberscope, the authors evaluated the epidural space in 73 women undergoing lumbar epidural anesthesia. Patients were classified into three groups: a nonpregnant group (n = 21), a first trimester pregnant group (8-13 weeks, n = 23), and a third-trimester pregnant group (27-39 weeks, n = 29). A 17-gauge Tuohy needle was inserted using the paramedian technique and the loss-of-resistance method with 5 ml air. The epiduroscope was introduced into the lumbar epidural space via the Tuohy needle and was advanced approximately 10 cm in a cephalad direction from the needle tip within the epidural space. The differences in the epidural space among the three groups then was evaluated. Results The epiduroscopy showed that the epidural pneumatic space, after injection of a given amount of air, was narrower and the density of the vascular network greater in the third-trimester group than in the other two groups. The amount of engorged blood vessels was greater in the third and first trimester groups than in the nonpregnant group. The amount of bleeding at the needle tip and the amount of fatty and fibrous connective tissue did not differ among the three groups. Conclusions Epidural blood vessels become engorged in the first trimester; the density of the vascular networks increase in the third trimester. These changes in the epidural space during pregnancy may affect the spread of epidural analgesia in pregnant women.

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Validation of a bioabsorbable device that seals perforations after Tuohy needle dural puncture in an ovine model

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-102225 ◽

2021 ◽

pp. rapm-2020-102225

Author(s):

Carles García-Vitoria ◽

Mireia García -Roselló ◽

Miguel A Reina ◽

Jose De Andres ◽

Álvaro Jesús Gutiérrez-Bautista ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Epidural Space ◽

Dural Puncture ◽

Tuohy Needle ◽

Epidural Needle ◽

Cerebrospinal Fluid Leakage ◽

Study Group ◽

Manufacturing Defects ◽

Fluid Leakage ◽

Sealing Device

BackgroundWe designed a device to close accidental dural puncture via the offending puncturing epidural needle directly after diagnosis of the puncture and before removing the needle. The aim of this study was to quantify this device’s ability to seal cerebrospinal fluid leakage.MethodsForty-six anesthetized adult sheep were studied in a single-blind randomized controlled fashion in two equal groups.An intentional dural puncture was performed with an 18-gage Tuohy needle on all the sheep between L6 and S1 levels. Contrast medium was injected through the needle. Twenty-three animals receive treatment with the sealing device. Two minutes after device placement, or dural puncture in the control group, a CT scan was performed on the animals to estimate contrast material leakage. A region of interest (ROI) was defined as the region that enclosed the subarachnoid space, epidural space, and neuroforaminal canal (the vertebral body above and half of its equivalent height in sacrum below the puncture site). In this region, the total contrast volume and the volumes in the epidural space (EPIDURAL) were measured. The primary outcome measure was the EPIDURAL/ROI ratio to ascertain the proportion of intrathecally injected fluid that passed into the epidural space in both groups. The secondary outcomes were the total amount of contrast in the ROI and the EPIDURAL.ResultsThe device was deployed successfully in all but two instances, where it suffered from manufacturing defects.Leakage was less in the study group (1.0 vs 1.4 mL, p=0.008). The median EPIDURAL/ROI ratio was likewise less in the study group (29 vs 46; p=0.013; 95% CI (−27 to –3.5)).ConclusionThis novel dural puncture-sealing device, also envisaged to be used in other comparable iatrogenic leakage scenarios to be identified in the future, was able to reduce the volume of cerebrospinal fluid that leaked into the epidural space after dural puncture. The device is possibly a valuable way of preventing fluid leakage immediately after the recognition of membrane puncture.

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Epidural Needle Extension through the Ligamentum Flavum Using the Standard versus the CompuFlo®-Assisted Loss of Resistance to Saline Technique: A Simulation Study

Anesthesiology Research and Practice ◽

10.1155/2020/9651627 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

E. Capogna ◽

A. Coccoluto ◽

M. Velardo

Keyword(s):

Epidural Space ◽

Simulation Study ◽

Ligamentum Flavum ◽

Standard Technique ◽

High Sensitivity ◽

Tuohy Needle ◽

Epidural Needle ◽

Loss Of Resistance ◽

The Mean ◽

Extension Length

Background. The CompuFlo® epidural system has been recently introduced and validated as an objective and sensible tool to detect the epidural space. We aimed to verify whether the high sensitivity of the instrument may help the anesthesiologist to identify the epidural space very early, limiting the extension of the Tuohy needle into the epidural space. Methods. In this prospective, simulation study, we evaluated the Tuohy needle extension through a simulated ligamentum flavum during the epidural procedure performed by 52 expert anesthesiologists by using the CompuFlo® epidural instrument or their standard loss of resistance to saline technique (LORT). Results. The mean (SD) needle extension length was 3.90 (3.71) mm in the standard technique group and 0.68 (0.46) mm in the CompuFlo® group (P<000001). The extremely reduced variability of the data in the CompuFlo® group (F test 0.01) made the results obtained with this instrument highly predictable. Conclusions. Puncturing high-resistance material that simulated the ligamentum flavum, the use of CompuFlo® has determined the arrest of the needle more precociously when compared with the traditional LORT.

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