Vaira Pasquale, Camorcia Michela, Palladino Tiziana, Velardo Matteo, Capogna Giorgio
Department of Anesthesiology, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, (FG), Italy.
Department of Anesthesiology, CdC Città di Roma, Rome, Italy.
Anesthesiol Res Pract. 2019 Feb 3;2019:5185901. doi: 10.1155/2019/5185901. eCollection 2019.
The occurrence of false losses of resistance may be one of the reasons for inadequate or failed epidural block. A CompuFlo® epidural instrument has been introduced to measure the pressure of human tissues in real time at the orifice of a needle and has been used as a tool to identify the epidural space. The aim of this study was to investigate the sensitivity and the specificity of the ability of CompuFlo® to differentiate the false loss of resistance from the true loss of resistance encountered during the epidural space identification procedure.
We performed epidural block with the CompuFlo® epidural instrument in 120 healthy women who requested labor epidural analgesia. The epidural needle was considered to have reached the epidural space when an increase in pressure (accompanied by an increase in the pitch of the audible tone) was followed by a sudden and sustained drop in pressure for more than 5 seconds accompanied by a sudden decrease in the pitch of the audible tone, resulting in the formation of a low and stable pressure plateau. We evaluate the sensitivity, specificity, and positive and negative predictive values of the ability of CompuFlo® recordings to correctly identify the true LOR from the false LOR.
The drop in pressure associated with the epidural space identification was significantly greater than that recorded after the false loss of resistance (73% vs 33%) (=0.000001). The sensitivity was 0.83, and the AUC was 0.82.
We have confirmed the ability of CompuFlo® to differentiate the false loss of resistance from the true loss of resistance and established its specificity and sensitivity.
An easier identification of dubious losses of resistance during the epidural procedure is essential to reduce the number of epidural attempts and/or needle reinsertions with the potential of a reduced risk of accidental dural puncture especially in difficult cases or when the procedure is performed by trainees.
阻力消失假象的出现可能是硬膜外阻滞不全或失败的原因之一。一种CompuFlo®硬膜外仪器已被引入，用于在针口实时测量人体组织压力，并已被用作识别硬膜外间隙的工具。本研究的目的是调查CompuFlo®在硬膜外间隙识别过程中区分阻力消失假象与真正阻力消失的能力的敏感性和特异性。
我们使用CompuFlo®硬膜外仪器对120名要求分娩硬膜外镇痛的健康女性进行硬膜外阻滞。当压力升高（伴随着可听音调的音高增加）后，压力突然持续下降超过5秒，同时可听音调的音高突然降低，形成一个低而稳定的压力平台时，硬膜外针被认为已到达硬膜外间隙。我们评估了CompuFlo®记录正确区分真正阻力消失与假象阻力消失的能力的敏感性、特异性以及阳性和阴性预测值。
与硬膜外间隙识别相关的压力下降显著大于阻力消失假象后记录的压力下降（73%对33%）（=0.000001）。敏感性为0.83，曲线下面积为0.82。
我们已经证实了CompuFlo®区分阻力消失假象与真正阻力消失的能力，并确定了其特异性和敏感性。
在硬膜外操作过程中更容易识别可疑的阻力消失对于减少硬膜外穿刺尝试次数和/或重新插入针的次数至关重要，尤其在困难病例或由实习生进行操作时，这有可能降低意外硬膜穿刺的风险。
