Utility of an Epidural Pressure Checker in the Administration of Trans-Laminar Epidural Blocks

Lee, Nam; Park, Sam Sun; Ji, Gyu Yeul; Kim, Byeong Woo; Lee, Chang Kyu; Kim, Eui Chul; Shin, Dong Ah

doi:2016.2.1.6

Asian J Pain > Volume 2;2016 > Article

Clinical Article

Asian Journal of Pain 2016;2(1):6-9.
DOI: https://doi.org/10.35353/ajp.2.1.6 Published online April 30, 2016.

Utility of an Epidural Pressure Checker in the Administration of Trans-Laminar Epidural Blocks

Nam Lee¹, Sam Sun Park², Gyu Yeul Ji², Byeong Woo Kim², Chang Kyu Lee², Eui Chul Kim², Dong Ah Shin²

¹Department of Neurosurgery, Dong-Eui Medical Center, Busan, Korea
²Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea

Correspondence: Dong Ah Shin, Tel: 82-2-2228-2150, Fax: 82-2-393-9979,
Email: shindongah@me.com

Abstract

Objective
Loss of resistance technique has been performed to identify the epidural space. However, this technique has some disadvantages including frequent lack of midline ligamentum flavum, erroneous subjective sensing, and higher failure rate. The aims of this study were to identify the optimal negative pressure representing the epidural space and to evaluate the efficacy of an epidural pressure checker to detect the epidural space.
Methods
Ninety-six patients who received a trans-laminar epidural block in the spine at our institute were enrolled. Half of them received a cervical epidural block (cervical group) and the other half received a lumbar epidural block (lumbar group). Patients were randomly assigned to one of the set pressure groups (-8, -7, -6, -5, -4, -3 mbar). When the needle penetrated the ligamentum flavum, the epidural pressure checker detected negative pressure at the epidural space and alarmed with sound and light if the pressure detected was below the set pressure.
Results
In the cervical group, detection rates were 62.5%, 75%, 75% at set pressure values of -8, -7, -6 mbar, respectively, and 87.5% at -5 mbar. In the lumbar group, rates were 50%, 62.5%, 62.5% at set pressure values of -8, -7, -6 mbar, respectively, and 87.5% at -5 mbar. False positives were frequent below a set pressure of -4 mbar.
Conclusion
The optimal pressure value to detect the epidural space was -5 mbar. The epidural pressure checker may be a reliable, easy and useful tool to aid in the administration of a trans-laminar epidural block.

Key Words: Epidural space; Pressure; Measurement; Epidural block; Epidural anesthesia.