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A pilot study to compare epidural identification and catheterization using a saline-filled syringe versus a continuous hydrostatic pressure system

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Abstract

We are introducing a new continuous hydrostatic pressure system for identification and catheterization of epidural space in adults. One hundred and eight patients scheduled for elective endoscopic urological procedures were enrolled in this prospective randomized study. They were assigned to perform loss of resistance epidural technique by either the conventional saline-filled syringe (group C) or the new pressure technique (group P). The latter depends on observing passage of free flow of pressurized normal saline (50 mmHg) connected to epidural needle during its advancement, and then the epidural catheter was inserted to “float” easily while saline was flowing. Ten ml of bupivacaine 0.5 % with 50 μg fentanyl were injected. Time to identify epidural space, number of attempts, ease of catheterization, sensory and motor block by Bromage scale after 20 min, quality of anesthesia and any side effects were recorded. Significant reduction was found in group P versus group C concerning time to identify epidural space [20 (6–40) vs. 60.5 (23–75) s with p = 0.001], number of attempts [1 (1–2) vs. 1 (1–4) with p = 0.02] and motor block [1 (0–3) vs. 2 (0–2) with p = 0.02], respectively. No significant difference in epidural catheterization, sensory block, quality of anesthesia and incidence of side effects. We concluded that this new technique is an easy way to identify epidural space using available tools in the operating room.

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Acknowledgments

The authors gratefully appreciate Dr. Tarek M. Diab, Assistant Professor in the Theodor Bilharz Research Institute, for his statistical consultation. The technique was deposited at the Office of patents in the Academy of the Scientific Research and Technology, Ministry of High Education and Scientific Research, Arab Republic of Egypt on 06/09/2009. This new technique achieved the second prize of the Academy of the Scientific Research and Technology (ASRT) offered during the Euro-Med Innovation Marketplace 26–28 January, 2010, Cairo, Egypt for the invention. It was chosen by the Academy of the Scientific Research and Technology to represent Egypt in Salon International des Inventions, Genève (Inventions Geneva), 5–10 April 2011, Geneva, Switzerland and obtained Silver Medal. This article has been presented as a poster-Discussion at the 86th International Anesthesia Research Society, (IARS). Boston, Massachusetts, USA; May 18–21, 2012. Anesth Analg Abstracts of Posters 2012;114:S-475.

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Authors and Affiliations

  1. Department of Anesthesia, Theodor Bilharz Research Institute, Ministry of Scientific Research, P.O. Box 30, Warak El-Hadar, Kornish El-Nile, Imbaba, Giza, 12411, Egypt

    Yasser M. Samhan, Hossam H. El-Sabae, Hanan F. Khafagy & Mohamed A. Maher

  2. 164 El Haram St, Giza, 12151, Egypt

    Hanan F. Khafagy

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  1. Yasser M. Samhan
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  2. Hossam H. El-Sabae
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  3. Hanan F. Khafagy
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  4. Mohamed A. Maher
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Correspondence to Hanan F. Khafagy.

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Samhan, Y.M., El-Sabae, H.H., Khafagy, H.F. et al. A pilot study to compare epidural identification and catheterization using a saline-filled syringe versus a continuous hydrostatic pressure system. J Anesth 27, 607–610 (2013). https://doi.org/10.1007/s00540-013-1567-y

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  • DOI: https://doi.org/10.1007/s00540-013-1567-y

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