Carassiti Massimiliano, Pascarella Giuseppe, Strumia Alessandro, Cataldo Rita, Antinolfi Vincenzo, Costa Fabio, Agrò Felice Eugenio
Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128, Rome, Italy.
J Clin Monit Comput. 2022 Feb;36(1):283-286. doi: 10.1007/s10877-021-00732-x. Epub 2021 Jun 20.
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.
腰椎硬膜外腔注射（EI）是疼痛治疗中一种可行的操作。尽管硬膜外镇痛被广泛应用，但它仍然是一种基于操作者手感的盲法技术，且失败率较高，并伴有多种潜在并发症。Compuflo®（Compuflo，里程碑科学公司，新泽西州利文斯顿）是一种电脑化注射泵，借助连续的液体路径，能精确检测置于人体组织中的 Tuohy 针尖端的实时压力。在我们机构，我们通常在 Compuflo 设备引导下进行慢性背痛的 EI 操作，尤其是针对预期难度较大的手术。然而，我们报告在总共 60 例手术中有 6 例假阴性病例，即 Compuflo 系统未达到硬膜外腔进入标准，尽管实际上已进入硬膜外腔。监测仪显示压力有轻微下降（小于 50%）且持续超过 5 秒，同时声音信号变低，但没有明确指示是否停止进针。这种监测压力的非特异性下降使用 Compuflo®系统时会产生假阴性结果，并可能导致进针过度。总之，我们认为硬膜外压力监测设备 Compuflo 是一种可能有助于硬膜外针正确定位的工具。然而，在我们的病例系列中硬膜外腔假阴性识别率为 10%，这表明需要对该硬膜外系统的适当或特定设置进行更多研究。同时，对于慢性疼痛患者，这种麻醉技术应由经验丰富的人员操作。
