Device for Determining Epidural Space Shows Promise

An ongoing multicenter trial is testing a novel computerized injection pump technology that the study authors say is as successful in identifying the epidural space as are fluoroscopy and loss of resistance.

"This technology originally comes from the dental arena," said Ralf E. Gebhard, MD, professor of anesthesiology, professor of orthopedics and rehabilitation, and chief of the Division of Regional Anesthesia and Acute Perioperative Pain Management at the University of Miami Miller School of Medicine. His comment was reported by Anesthesiology News in an article in September.1

"One of my colleagues went to the dentist and received an injection without any pain," Gebhard told the news site. When he asked about it, the dentist showed him the injection pump technology, which allows clinicians to give slow, controlled injections that don't cause any pain," said Gebhard.

Gebhard presented preliminary findings on 204 patients at the 2016 meeting of the American Society of Regional Anesthesia and Pain Medicine (abstract 1210).

In the device, the tip of the epidural needle can measure pressure. When that technology is combined with real-time graphic, acoustic, and numeric display of such pressures via a computerized injection pump, it has been demonstrated to identify the epidural space.1

In the current study, Dr. Gebhard and his colleagues are comparing the technology with both fluoroscopy and the loss-of-resistance approaches.

Gebhard told Anesthesiology News that the technology gives anesthesiologists more options for correctly determining the epidural space.

"Unless you use fluoroscopy, the biggest problem with epidural anesthesia is that you don't have an objective way of identifying the epidural space," he told Anesthesiology News. "And in many scenarios you cannot use fluoroscopy, so we are relying on the subjective feeling of loss of resistance with our hands. But we know our hands are not the greatest tools, so this technology gives us an objective way of verifying true loss of resistance, and consequently, the true identification of the epidural space.1

Gebhard continued, "And that's why I think this is a game changer; because over the last hundred years or so, really nothing much has changed with epidural anesthesia."

However, he noted that the FDA would like see more data about safety and potential adverse events. "Obviously the FDA is concerned when you introduce a computerized injection pump into the epidural space," Gebhard noted. "They're concerned about technology failure. So far we haven't seen that, but the final data are still outstanding."1

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