Kartal S, Kösem B, Kılınç H, Köşker H, Karabayırlı S, Çimen N K, Demircioğlu R I
Department of Anesthesiology and Reanimation, Faculty of Medicine, Turgut Ozal University, Ankara, Turkey.
Department of Gynecology and Obstetrics, Faculty of Medicine, Turgut Ozal University, Ankara, Turkey.
Niger J Clin Pract. 2017 Aug;20(8):992-997. doi: 10.4103/1119-3077.214366.
Identifying the epidural space is essential during epidural anesthesia (EA). Pressure of the epidural space in pregnancy is higher than that in nonpregnant woman. Loss of resistance (LOR) method is the most commonly preferred method for identifying the epidural space. Epidrum and Epi-Jet are recently innovated supporting devices that facilitate identifying process for epidural space. In this study we aimed to compare Epidrum, Epi-Jet, and LOR methods in identifying the epidural space, feasibility of technique.
Two hundred and forty pregnant women who were scheduled for caesarian section surgery under lumbar EA or combined spinal epidural anesthesia (CSEA) were randomized into three groups (Group I Epidrum, n = 80), Group II (Epi-Jet, n = 80), and Group III (LOR, n = 80). We recorded the time required to identify the epidural space and deflation of Epidrum balloon and Epi-Jet syringe, number of attempts, additional methods used to identify epidural space, usefulness of methods, accuracy of identification of epidural space, and outcomes of epidural catheterization.
There were no significant differences between the groups with respect to demographic data, duration of deflation of Epidrum balloon and Epi-Jet syringe and distance between skin and epidural space. The mean time required to enter epidural space in Group I was shorter than that in Group II (P = 0.031). Feasibility of Epi-Jet was easier than that of Epidrum (P = 0.015). Number of uncertainties of epidural space identification was higher in Group I than that in Group II (P = 0.009). Also, the requirement for LOR to confirm epidural space and failure rates was higher in Group I than Group II (P < 0.001).
We suggest that Epi-Jet is superior to Epidrum in pregnant patients in terms of clarity of epidural space identification, usefulness, and success rates of EA or CSEA.
在硬膜外麻醉（EA）过程中，识别硬膜外间隙至关重要。孕期硬膜外间隙压力高于非孕期女性。阻力消失（LOR）法是识别硬膜外间隙最常用的首选方法。Epidrum和Epi-Jet是最近创新的辅助装置，有助于硬膜外间隙的识别过程。在本研究中，我们旨在比较Epidrum、Epi-Jet和LOR法在识别硬膜外间隙方面的效果及技术可行性。
240例计划在腰段EA或腰麻-硬膜外联合麻醉（CSEA）下行剖宫产手术的孕妇被随机分为三组（I组Epidrum，n = 80）、II组（Epi-Jet，n = 80）和III组（LOR，n = 80）。我们记录了识别硬膜外间隙所需时间、Epidrum球囊和Epi-Jet注射器的放气时间、尝试次数、用于识别硬膜外间隙的其他方法、方法的实用性、硬膜外间隙识别的准确性以及硬膜外导管置入的结果。
三组在人口统计学数据、Epidrum球囊和Epi-Jet注射器的放气持续时间以及皮肤与硬膜外间隙之间的距离方面无显著差异。I组进入硬膜外间隙的平均时间短于II组（P = 0.031）。Epi-Jet的可行性优于Epidrum（P = 0.015）。I组硬膜外间隙识别的不确定次数高于II组（P = 0.009）。此外，I组确认硬膜外间隙所需的LOR次数和失败率高于II组（P < 0.001）。
我们认为，在孕妇中，就硬膜外间隙识别的清晰度、实用性以及EA或CSEA的成功率而言，Epi-Jet优于Epidrum。
