Abstract
Lumbar epidural infiltration (EI) is a feasible procedure performed in pain therapy. Even though epidural analgesia is widely applied, it remains a blind technique, based on the operator’s hand sensations, and it is associated with significant failure rate and several potential complications. Compuflo® (Compuflo, Milestone Scientific, Livingston, NJ) is a computerized injection pump which precisely detects the real time pressure at the tip of a Tuohy needle when placed in human tissues, thanks to a continuous fluid path. In our institution, we usually perform EI for chronic back pain guided by the Compuflo device, especially for expected difficult procedures. However, we report 6 false negative cases on a total number of 60 procedures in which the Compuflo system didn’t meet the criteria of epidural space entry, even though the epidural space was actually reached. A mild pressure decrease (less than 50%) which lasted for more than 5 s was reported on the monitor, and the acoustic signal changed in a little bit lower sound, without a clear indication on stopping or not the needle advancement. This unspecific drop in monitored pressure gives false negatives using the Compuflo® system and may lead to excessive advancing of the needle. In conclusion, we consider the epidural pressure monitoring device Compuflo as a tool which may be able to ease the correct positioning of an epidural needle. The percentage of 10% false negative identifications of the epidural space in our case series however suggests more investigations on adequate or specific settings for this epidural system. In the meantime, in chronic pain patients, this anesthetic technique should only be used by experienced hands.
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References
Yang S, Kim W, Kong HH, Do KH, Choi KH. Epidural steroid injection versus conservative treatment for patients with lumbosacral radicular pain: a meta-analysis of randomized controlled trials. Medicine. 2020;99(30):e21283.
Carassiti M, Di Martino A, Centonze A, Quattrocchi CC, Caldaria A, Agrò F, et al. Failed back surgery syndrome: a new strategy by the epidural injection of MESNA. Musculoskelet Surg. 2018;102(2):179–84.
Hermanides J, Hollmann MW, Stevens MF, Lirk P. Failed epidural: causes and management. Br J Anaesth. 2012;109(2):144–54.
Buddeberg BS, Bandschapp O, Girard T. Post-dural puncture headache. Minerva Anestesiol. 2019;85(5):543–53.
Ruppen W, Derry S, McQuay H, Moore RA. Incidence of epidural hematoma, infection, and neurologic injury in obstetric patients with epidural analgesia/anesthesia. Anesthesiology. 2006;105(2):394–9.
De Tommaso O, Caporuscio A, Tagariello V. Neurological complications following central neuraxial blocks: are there predictive factors? Eur J Anaesthesiol. 2002;19(10):705–16.
Carassiti M, Cataldo R, Formica D, Massaroni C, De Filippis A, Palermo P, et al. A new pressure guided management tool for epidural space detection: feasibility assessment in a clinical scenario. Minerva Anestesiol. 2020
Carassiti M, Quarta R, Mattei A, Tesei M, Saccomandi P, Massaroni C, et al. Ex vivo animal-model assessment of a non-invasive system for loss of resistance detection during epidural blockade. Annu Int Conf IEEE Eng Med Biol Soc. 2017;2017:759–62.
Tesei M, Saccomandi P, Massaroni C, Quarta R, Carassiti M, Schena E et al, editors. A cost-effective, non-invasive system for pressure monitoring during epidural needle insertion: Design, development and bench tests. In: 2016 38th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC); 2016 16–20 Aug 2016.
Capogna G, Camorcia M, Coccoluto A, Micaglio M, Velardo M. Experimental validation of the CompuFlo® epidural controlled system to identify the epidural space and its clinical use in difficult obstetric cases. Int J Obstet Anesth. 2018;36:28–33.
Gebhard RE, Moeller-Bertram T, Dobecki D, Peralta F, Pivalizza EG, Rupasinghe M, et al. Objective epidural space identification using continuous real-time pressure sensing technology: a randomized controlled comparison with fluoroscopy and traditional loss of resistance. Anesth Analg. 2019;129(5):1319–27.
Vaira P, Camorcia M, Palladino T, Velardo M, Capogna G. Differentiating false loss of resistance from true loss of resistance while performing the epidural block with the CompuFlo® epidural instrument. Anesthesiol Res Practice. 2019;2019:5185901.
Bosscher HA, Heavner JE. Incidence and severity of epidural fibrosis after back surgery: an endoscopic study. Pain Pract. 2010;10(1):18–24.
Marchesini M, Flaviano E, Bellini V, Baciarello M, Bignami EG. Complication of epiduroscopy: a brief review and case report. Korean J Pain. 2018;31(4):296–304.
Sprigge JS, Harper SJ. Accidental dural puncture and post dural puncture headache in obstetric anaesthesia: presentation and management: a 23-year survey in a district general hospital. Anaesthesia. 2008;63(1):36–43.
Ehrenfeld JM, Agarwal AK, Henneman JP, Sandberg WS. Estimating the incidence of suspected epidural hematoma and the hidden imaging cost of epidural catheterization: a retrospective review of 43,200 cases. Reg Anesth Pain Med. 2013;38(5):409–14.
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Carassiti, M., Pascarella, G., Strumia, A. et al. Pressure monitoring devices may undetect epidural space: a report on the use of Compuflo® system for epidural injection. J Clin Monit Comput 36, 283–286 (2022). https://doi.org/10.1007/s10877-021-00732-x
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DOI: https://doi.org/10.1007/s10877-021-00732-x