NEGATIVE PRESSURE OF THE EPIDURAL SPACE

Cervical epidural injection (CEI), which is widely used for the treatment of cervical radiculopathy, sometimes has been associated with post-operative complications. Recently, EPI-DetectionTM, which detects the negative pressure of the epidural space and notifies the proceduralist by flashing a light and producing a beeping sound, was introduced. We assumed that the newly developed device could be as safe and efficient as the conventional loss of resistance (LOR) method. Therefore, we aimed to evaluate the effectiveness of the EPI-DetectionTM and compare it to that of the conventional LOR method. We randomly assigned 57 patients to the LOR and EPI-Detection groups (29 and 28 patients, respectively). Subjects were treated with interlaminar CEI (ILCEI) using one of two methods. The measured parameters, i.e., operation time and radiation dose were lower in the EPI-DetectionTM group (4.6 ± 1.2 min vs. 6.9 ± 2.1 min; and 223.2 ± 206.7 mGy·cm2 vs. 380.3 ± 340.9 mGy·cm2, respectively; all p < 0.05) than in the LOR group. There were no complications noted in either group. Both the EPI-DetectionTM and LOR methods were safe and effective in detecting the epidural space, but the former was superior to the latter in terms of operation time and radiation exposure. The EPI-DetectionTM may help perform ILCEI safely.

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Genesis of the 'True' Negative Pressure In the Lumbar Epidural Space A New Hypothesis

Obstetric Anesthesia Digest ◽

10.1097/00132582-198506000-00026 ◽

1985 ◽

Vol 5 (2) ◽

pp. 69

Author(s):

E. Zarzur

Keyword(s):

Epidural Space ◽

Negative Pressure ◽

True Negative ◽

New Hypothesis

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Cervical Epidural Pressure Measurement

Anesthesiology ◽

10.1097/aln.0b013e3181e898e8 ◽

2010 ◽

Vol 113 (3) ◽

pp. 666-671 ◽

Cited By ~ 4

Author(s):

Jee Y. Moon ◽

Pyung-Bok Lee ◽

Francis Sahngun Nahm ◽

Yong-Chul Kim ◽

Jong-Bum Choi

Keyword(s):

Prone Position ◽

Epidural Space ◽

Negative Pressure ◽

Pressure Measurement ◽

Sitting Position ◽

Fluoroscopic Guidance ◽

Hanging Drop ◽

Epidural Pressure ◽

Drop Technique ◽

Pressure Measurement System

Background The hanging drop technique is used for identifying the cervical epidural space, using its negative pressure. However, it is doubtful whether the epidural space intrinsically exhibits a negative pressure. We designed this study to test the hypothesis that the cervical epidural pressure (CEP) is significantly higher in the prone position than in the sitting position. To evaluate this hypothesis, we measured and compared 30 CEP values in the prone and sitting positions. Methods We measured and compared 15 CEPs in the prone group and 15 in the sitting group using a closed pressure measurement system under fluoroscopic guidance. Results All CEPs in the prone group were consistently positive (median, 10 mmHg; range, 4.8-18.7; mean+/-SD, 10.5+/-4.4) in contrast to the sitting group (median, -0.3 mmHg; range, -2.4-7.9; mean+/-SD, 0.5+/-2.8). CEPs in the prone group were significantly higher than in the sitting group (P<0.001). Conclusion CEP was found to be significantly higher in the prone position than in the sitting position. Furthermore, CEPs were not consistently negative even in the sitting position. These results suggest that the hanging drop technique is inappropriate for identifying the cervical epidural space in either the prone or sitting positions. Clinical Trials Ref: NCT01009385.

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