Identification of Epidural Space Description of New Technique
Condition: Anesthesia
Study type: Interventional

Summary: 
      Introduction Several attempts have been made to improve or facilitate epidural space
      detection beside conventional loss of resistant technique. Recently many sophisticated
      equipment's and techniques have been described which did not received widespread popularity.

      Objectives The Investigator describes and assesses the validity of using Pressure Gauge
      Manometer to confirm correct detection of lumber epidural space, in an inexpensive way.

      Methods Tuohy needle is introduced into intervertebral space at the level of L3-L4 up to the
      interspinous ligaments ( nearly 2cm mark on the needle).A3-way stopcock is connected to the
      hub of Tuohy needle with the in-line port of the stopcock attached to an air-filled 10 ml
      syringe. Using a 75 cm extension tube set and create a 30 mm Hg pressure gradient between
      manometer and the tip of epidural needle , the needle is advanced slowly using both hands
      while monitoring the manometer reading and is stopped when the pressure suddenly dropped (
      the pressure usually drops by 5-10 mm Hg when the tip of the needle inters the epidural space
      ).
    

Detailed description: 
      • A total of 60 consecutive ASA class 1& II patients of ages between 28-68 years scheduled
      for elective surgery under lumber epidural anesthesia or under general anesthesia with
      planned post-operative epidural analgesia were enrolled in this study.

      Patients with known coagulation disorder, allergy to local anesthetics, skin lesions at the
      puncture side, or neuromuscular disease were not included.

      Patients are placed in sitting position and American society of anesthesiologists standard
      monitors attached. After skin preparation, draping, and local anesthetic infiltration, an
      epidural Tuohy needle is introduced into intervertebral space at the level of L3-L4 up to the
      interspinous ligaments ( nearly 2cm mark on the needle). Fig 1 A3-way stopcock is connected
      to the hub of Tuohy needle with the in-line port of the stopcock attached to an air-filled 10
      ml syringe. Using a 75 cm extension tube set the side port is connected to the Pressure Gauge
      Manometer held by the assistant. The stopcock is turned so that the needle is in direct
      continuity with both syringe and pressure Gage manometer. The syringe is used to create a 30
      mm Hg pressure reading on the manometer, the stopcock then is turned into "open" to manometer
      and Tuohy needle and "close" to syringe.

      With this 30 mm Hg pressure gradient between manometer and the tip of epidural needle, the
      needle is advanced slowly using both hands while monitoring the manometer reading and is
      stopped when the pressure changes ( the pressure usually drops by 5-10 mm Hg when the tip of
      the needle inters the epidural space ).

      The 3-way is then removed and local anesthetic is injected for single shot epidural block or
      catheter is introduced in the conventional manner and secured by adhesive tap.

      Procedure was performed by anesthetists of different levels of experience (consultant,
      specialist, resident).

      Demographic data and type of surgery is recorded along with time of the technique, number of
      passes required to enter the epidural space, any false LOR, insertion difficulties,
      accidental dural puncture, or any other complication occurred.
    

Intervention name(s): Pressure Gauge Manometer
Intervention type(s): Device
Intervention description(s): Identification of epidural space
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Epidural Identification pressure gauge