• Oscar Ghelber, Ralf E Gebhard, Sejal Vora, Carin A Hagberg, and Peter Szmuk.
• Department of Anesthesiology, The University of Texas Medical School at Houston, Houston, TX, USA.
• Reg Anesth Pain Med. 2008 Jul 1;33(4):346-52.

Background And ObjectivesWhile epidural anesthesia (EA) is frequently used, success rate varies and complications associated with incorrect needle placement can occur. Different methods of objective identification of the epidural space (ES) have been suggested, without receiving widespread popularity. This prospective pilot study evaluated continuous pressure measurement during low speed injection with a computerized injection pump to objectively identify the ES.MethodsWhile EA was performed using a conventional loss of resistance technique in 20 consecutive patients, the injection pump technology was used to obtain pressure readings from the supraspinous ligament, the ligamentum flavum, and the ES. In the next 20 patients, the epidural space was solely identified with the computerized injection pump.ResultsPressure reading obtained during the first part of the study revealed significant differences between the ES vs. the supraspinous ligament, and the ES vs. the ligamentum flavum (8 mm Hg, 95% confidence interval [CI] 6-11 vs 79 mm Hg, 95% CI 74-83 and 92 mm Hg, 95% CI 83-102, respectively) (P < .001). In the second part of the study, the injection pump allowed for successful identification of the ES and performance of EA in all 20 patients.ConclusionsThis investigation demonstrates that a computerized injection pump can be used to identify the epidural space and can serve as a base for further comparative research to determine whether this technology can increase the success rate of EA or lower the incidence of side effects.

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