Instrumentation of the Loss-of-Resistance Technique for Epidural Needle Insertion

2009 ◽  
Vol 56 (3) ◽  
pp. 820-827 ◽  
Author(s):  
D. Tran ◽  
King-Wei Hor ◽  
A.A. Kamani ◽  
V.A. Lessoway ◽  
R.N. Rohling
Keyword(s):  
Needle Insertion ◽  
Epidural Needle ◽  
Loss Of Resistance

In-Vivo Obstetric Pressure Measurements for Patient-Specific Epidural Simulator

2014 ◽  
Author(s):  
Neil Vaughan ◽  
Venketesh N. Dubey ◽  
Michael Y. K. Wee ◽  
Richard Isaacs
Keyword(s):  
Needle Insertion ◽  
Epidural Needle ◽  
Patient Specific ◽  
Pressure Measurements ◽  
Epidural Pressure ◽  
Loss Of Resistance ◽  
New Finding ◽  
The Mean ◽  
Thickness Measurements

The aim of this study was to measure changing pressures during Tuohy epidural needle insertions for obstetric parturients of various BMI. This has identified correlations between BMI and epidural pressure. Also we investigated links between BMI and the thicknesses and depths of ligaments and epidural space as measured from MRI and ultrasound scans. To date there have been no studies relating epidural pressure and ligament thickness changes with varying Body Mass Indices (BMI). Further goals following measurement of pressure differences between various BMI patients, were to allow a patient-specific epidural simulator to be developed, which has not been achieved before. The trial has also assessed the suitability of our in-house developed wireless pressure measurement device for use in-vivo. Previously we conducted needle insertion trial with porcine for validation of the measurement system. Results showed that for each group average pressures during insertion decrease as BMI increases. Pressure measurements obtained from the patients were matched to tissue thickness measurements from MRI and ultrasound scans. The mean Loss of Resistance (LOR) pressure in each group reduces as BMI increases. Variation in the shape of the pressure graphs was noticed between two epiduralists performing the procedure, suggesting each anaesthetist may have a signature graph shape. This is a new finding which offers potential use in epidural training and assessment. It can be seen that insertions performed by the first epiduralist have a higher pressure range than insertions performed by second epiduralist.

Haptic Interface on Measured Data for Epidural Simulation

2012 ◽  
Author(s):  
Neil Vaughan ◽  
Venketesh N. Dubey ◽  
Michael Y. K. Wee ◽  
Richard Isaacs
Keyword(s):  
Force Feedback ◽  
Development Program ◽  
Needle Insertion ◽  
Haptic Device ◽  
Epidural Needle ◽  
High Fidelity ◽  
3D Graphics ◽  
Tissue Layer ◽  
Loss Of Resistance ◽  
Force Data

This paper presents a haptic device with 3D computer graphics as part of a high fidelity medical epidural simulator development program. The haptic device is used as an input to move the needle in 3D, and also to generate force feedback to the user during insertion. A needle insertion trial was conducted on a porcine cadaver to obtain force data. The data generated from this trial was used to recreate the feeling of epidural insertion in the simulator. The interaction forces have been approximated to the resultant force obtained during the trial representing the force generated by the haptic device. The haptic device is interfaced with the 3D graphics for visualization. As the haptic stylus is moved, the needle moves on the screen and the depth of the needle tip indicates which tissue layer is being penetrated. Different forces are generated by the haptic device for each tissue layer as the epidural needle is inserted. As the needle enters the epidural space, the force drops to indicate loss of resistance.

Cervical and High Thoracic Ligamentum Flavum Frequently Fails to Fuse in the Midline

2003 ◽  
Vol 99 (6) ◽  
pp. 1387-1390 ◽  
Author(s):  
Philipp Lirk ◽  
Christian Kolbitsch ◽  
Guenther Putz ◽  
Joshua Colvin ◽  
Hans Peter Colvin ◽  
...  
Keyword(s):  
Ligamentum Flavum ◽  
Epidural Needle ◽  
Complete Fusion ◽  
Thoracic Epidural ◽  
Loss Of Resistance ◽  
Ligamenta Flava ◽  
Mean Width ◽  
Human Cadavers ◽  
The Mean ◽  
High Thoracic Epidural

Background Cervical and high thoracic epidural anesthesia and analgesia have gained increasing importance in the treatment of painful conditions and as components of anesthetics for cardiac and breast surgery. In contrast to the hanging-drop technique, the loss-of-resistance technique is thought to rely on the penetration of the ligamentum flavum. However, the exact morphology of the ligamentum flavum at different vertebral levels remains controversial. Therefore, the aim of this study was to investigate the incidence and morphology of cervical and high thoracic ligamentum flavum mid-line gaps in embalmed cadavers. Methods Vertebral column specimens were obtained from 52 human cadavers. On each dissected level, ligamentum flavum mid-line gaps were recorded and evaluated with respect to shape and size. Results The following variations were encountered: complete fusion in the mid-line, mid-line fusion with a gap in the caudal part, mid-line gap, and mid-line gap with widened caudal end. The incidence of mid-line gaps at the following levels was: C3-C4: 66%, C4-C5: 58%, C5-C6: 74%, C6-C7: 64%, C7-T1: 51%, Th1-Th2: 21%, Th2-Th3: 11%, Th3-Th4: 4%, Th4-Th5: 2%, and Th5-Th6: 2%. The mean width of mid-line gaps was 1.0 +/- 0.3 mm. Conclusions In conclusion, the present study shows that gaps in the ligamenta flava are frequent at cervical and high thoracic levels but become rare at the T3/T4 level and below, such that one cannot always rely on the ligamentum flavum as a perceptible barrier to epidural needle placement at these levels.

Epidural needle insertion

2018 ◽  
Vol 67 (12) ◽  
pp. 922-930 ◽  
Author(s):  
H. Bomberg ◽  
N. Paquet ◽  
A. Huth ◽  
S. Wagenpfeil ◽  
P. Kessler ◽  
...  
Keyword(s):  
Needle Insertion ◽  
Epidural Needle

Penetration detection with intention recognition for cooperatively controlled robotic needle insertion

2022 ◽  
pp. 014233122110693
Author(s):  
Yiyun Wang ◽  
Hongbing Li
Keyword(s):  
Lumbar Puncture ◽  
Needle Insertion ◽  
Robot System ◽  
Position Information ◽  
Tissue Properties ◽  
Intention Recognition ◽  
Loss Of Resistance ◽  
Recognition Ability ◽  
Robot Cooperation ◽  
Penetration Detection

In lumbar puncture surgeries, force and position information throughout the insertion procedure is vital for needle tip localization, because it reflects different tissue properties. Especially in pediatric cases, the changes are always insignificant for surgeons to sense the crucial feeling of loss of resistance. In this study, a robot system is developed to tackle the major clinical difficulties. Four different control algorithms with intention recognition ability are applied on a novel lumbar puncture robot system for better human–robot cooperation. Specific penetration detection based on force and position derivatives captures the feeling of loss of resistance, which is deemed crucial for needle tip location. Kinematic and actuation modeling provides a clear description of the hardware setup. The control algorithm experiment compares the human–robot cooperation performance of proposed algorithms. The experiment also dictates the clear role of designed penetration detection criteria in capturing the penetration, improving the success rate, and ensuring operational safety.

scholarly journals EMLA Cream Prior to Insertion of Elective Epidurals

1995 ◽  
Vol 23 (3) ◽  
pp. 339-341 ◽  
Author(s):  
J. A. Elson ◽  
M. J. Paech
Keyword(s):  
Elective Caesarean Section ◽  
Needle Insertion ◽  
Patient Comfort ◽  
Epidural Needle ◽  
Double Blind Study ◽  
Double Blind ◽  
Emla Cream ◽  
Skin Infiltration ◽  
Group A ◽  
Group B

A randomized double-blind study was conducted in 83 women scheduled for elective caesarean section to determine the efficacy of EMLA and lignocaine infiltration for epidural insertion. The patients were randomly allocated to one of three groups: Group A (EM/LIG) received EMLA and intradermal and subdermal 1% lignocaine infiltration, Group B (EM/SAL) EMLA and saline while Group C (PL/LIG) received placebo cream and 1% lignocaine. Assessments using a 100 mm pain score were performed on skin infiltration and after subsequent insertion of a 16 gauge Tuohy needle into the supraspinous ligament. Skin changes under the applied cream and nursing rating of patients’ response were also noted. Statistical analyses were performed using Kruskal-Wallis and Fisher's Exact Tests. Groups were comparable for age, weight, parity and EMLA application time (interquartile range 105-150 minutes) There were significantly higher pain scores for skin infiltration in Group C (PL/LIG) (P<0.01) and for epidural needle insertion in Group B (EM/SAL) (P<0.05). We concluded that in this patient population, the application of EMLA cream for at least 90 minutes plus 1% lignocaine infiltration optimized patient comfort for epidural insertion.

Real-time Ultrasound-Guided Lumbar Epidural with Transverse Interlaminar View: Evaluation of an In-Plane Technique

Pain Medicine ◽  
2019 ◽  
Vol 20 (9) ◽  
pp. 1750-1755 ◽  
Author(s):  
Hesham Elsharkawy ◽  
Wael Saasouh ◽  
Rovnat Babazade ◽  
Loran Mounir Soliman ◽  
Jean-Louis Horn ◽  
...  
Keyword(s):  
Success Rate ◽  
Real Time ◽  
Epidural Anesthesia ◽  
Needle Insertion ◽  
Adult Patients ◽  
Epidural Needle ◽  
Anatomical Landmarks ◽  
Care Hospital ◽  
Open Prostatectomy ◽  
Ultrasound Guided

Abstract Objective The anatomical landmarks method is currently the most widely used technique for epidural needle insertion and is faced with multiple difficulties in certain patient populations. Real-time ultrasound guidance has been recently used to aid in epidural needle insertion, with promising results. Our aim was to test the feasibility, success rate, and satisfaction associated with a novel real-time ultrasound-guided lumbar epidural needle insertion in the transverse interlaminar view. Design Prospective descriptive trial on a novel approach. Setting Operating room and preoperative holding area at a tertiary care hospital. Subjects Adult patients presenting for elective open prostatectomy and planned for surgical epidural anesthesia. Methods Consented adult patients aged 30–80 years scheduled for open prostatectomy under epidural anesthesia were enrolled. Exclusion criteria included allergy to local anesthetics, infection at the needle insertion site, coagulopathy, and patient refusal. A curvilinear low-frequency (2–5 MHz) ultrasound probe and echogenic 17-G Tuohy needles were used by one of three attending anesthesiologists. Feasibility of epidural insertion was defined as a 90% success rate within 10 minutes. Results Twenty-two patients were enrolled into the trial, 14 (63.6%) of whom found the process to be satisfactory or very satisfactory. The median time to perform the block was around 4.5 minutes, with an estimated success rate of 95%. No complications related to the epidural block were observed over the 48 hours after the procedure. Conclusions We demonstrate the feasibility of a novel real-time ultrasound-guided epidural with transverse interlaminar view.

Successful transforaminal epidural blood patch in a patient with multilevel spinal fusion

2020 ◽  
Vol 45 (9) ◽  
pp. 746-749
Author(s):  
Hanwool Ryan Choi ◽  
Benjamin Fuller ◽  
Michael Magdy Bottros
Keyword(s):  
Case Report ◽  
Spinal Fusion ◽  
Epidural Blood Patch ◽  
Autologous Blood ◽  
Anatomical Variations ◽  
Needle Insertion ◽  
Electrode Placement ◽  
Epidural Needle ◽  
First Case ◽  
Blood Patch

IntroductionEpidural blood patch (EBP) is a vital tool in treating postdural puncture headache (PDPH). Traditional interlaminar epidural needle insertion into the epidural space, however, may be challenging due to anatomical variations. As an alternative method, we successfully performed an EBP via transforaminal approach.Case reportA mid-50-year-old male patient with multilevel spinal fusion developed PDPH after a failed spinal cord stimulator electrode placement. A transforaminal EBP was carried out by injecting a total of 8 mL of autologous blood into the neuroforamen at the L1–L2 level bilaterally. Our patient’s positional headache resolved immediately after the procedure.DiscussionTo our knowledge, this is the first case reported of a transforaminal EBP in a patient with diffuse epidural adhesive fibrosis secondary to multilevel laminectomies and spinal fusion. This case report highlights potential risks and benefits of this novel technique and also discusses its therapeutic mechanism of action. We believe that a transforaminal EBP should be considered in patients who are poor candidates for the traditional interlaminar EBP.

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