Localization of epidural space: A review of available technologies

Although epidural analgesia is widely used for pain relief, it is associated with a significant failure rate. Loss of resistance technique, tactile feedback from the needle, and surface landmarks are traditionally used to guide the epidural needle tip into the epidural space (EDS). The aim of this n...

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Main Authors: Hesham Elsharkawy, Abraham Sonny, Ki Jinn Chin
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2017-01-01
Series:Journal of Anaesthesiology Clinical Pharmacology
Subjects:
Online Access:http://www.joacp.org/article.asp?issn=0970-9185;year=2017;volume=33;issue=1;spage=16;epage=27;aulast=Elsharkawy
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spelling doaj-f72e0b5864e9414e9df628cbc485a6692020-11-24T20:42:48ZengWolters Kluwer Medknow PublicationsJournal of Anaesthesiology Clinical Pharmacology0970-91852017-01-01331162710.4103/0970-9185.202184Localization of epidural space: A review of available technologiesHesham ElsharkawyAbraham SonnyKi Jinn ChinAlthough epidural analgesia is widely used for pain relief, it is associated with a significant failure rate. Loss of resistance technique, tactile feedback from the needle, and surface landmarks are traditionally used to guide the epidural needle tip into the epidural space (EDS). The aim of this narrative review is to critically appraise new and emerging technologies for identification of EDS and their potential role in the future. The PubMed, Cochrane Central Register of Controlled Clinical Studies, and Web of Science databases were searched using predecided search strategies, yielding 1048 results. After careful review of abstracts and full texts, 42 articles were selected to be included. Newer techniques for localization of EDS can be broadly classified into techniques that (1) guide the needle to the EDS, (2) identify needle entry into the EDS, and (3) confirm catheter location in EDS. An ideal method should be easy to learn and perform, easily reproducible with high sensitivity and specificity, identifies inadvertent intrathecal and intravascular catheter placements with ease, feasible in perioperative setting and have a cost-benefit advantage. Though none of them in their current stages of development qualify as an ideal method, many show tremendous potential. Some techniques are useful in patients with difficult spinal anatomy and infants, and thus are complementary to traditional methods. In addition to improving the existing technology, future research should aim at proving the superiority of these techniques over traditional methods, specifically regarding successful EDS localization, better safety profile, and a favorable cost-benefit ratio.http://www.joacp.org/article.asp?issn=0970-9185;year=2017;volume=33;issue=1;spage=16;epage=27;aulast=ElsharkawyEpidural localizationepidural spaceloss of resistancenew technologies
collection DOAJ
language English
format Article
sources DOAJ
author Hesham Elsharkawy
Abraham Sonny
Ki Jinn Chin
spellingShingle Hesham Elsharkawy
Abraham Sonny
Ki Jinn Chin
Localization of epidural space: A review of available technologies
Journal of Anaesthesiology Clinical Pharmacology
Epidural localization
epidural space
loss of resistance
new technologies
author_facet Hesham Elsharkawy
Abraham Sonny
Ki Jinn Chin
author_sort Hesham Elsharkawy
title Localization of epidural space: A review of available technologies
title_short Localization of epidural space: A review of available technologies
title_full Localization of epidural space: A review of available technologies
title_fullStr Localization of epidural space: A review of available technologies
title_full_unstemmed Localization of epidural space: A review of available technologies
title_sort localization of epidural space: a review of available technologies
publisher Wolters Kluwer Medknow Publications
series Journal of Anaesthesiology Clinical Pharmacology
issn 0970-9185
publishDate 2017-01-01
description Although epidural analgesia is widely used for pain relief, it is associated with a significant failure rate. Loss of resistance technique, tactile feedback from the needle, and surface landmarks are traditionally used to guide the epidural needle tip into the epidural space (EDS). The aim of this narrative review is to critically appraise new and emerging technologies for identification of EDS and their potential role in the future. The PubMed, Cochrane Central Register of Controlled Clinical Studies, and Web of Science databases were searched using predecided search strategies, yielding 1048 results. After careful review of abstracts and full texts, 42 articles were selected to be included. Newer techniques for localization of EDS can be broadly classified into techniques that (1) guide the needle to the EDS, (2) identify needle entry into the EDS, and (3) confirm catheter location in EDS. An ideal method should be easy to learn and perform, easily reproducible with high sensitivity and specificity, identifies inadvertent intrathecal and intravascular catheter placements with ease, feasible in perioperative setting and have a cost-benefit advantage. Though none of them in their current stages of development qualify as an ideal method, many show tremendous potential. Some techniques are useful in patients with difficult spinal anatomy and infants, and thus are complementary to traditional methods. In addition to improving the existing technology, future research should aim at proving the superiority of these techniques over traditional methods, specifically regarding successful EDS localization, better safety profile, and a favorable cost-benefit ratio.
topic Epidural localization
epidural space
loss of resistance
new technologies
url http://www.joacp.org/article.asp?issn=0970-9185;year=2017;volume=33;issue=1;spage=16;epage=27;aulast=Elsharkawy
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AT kijinnchin localizationofepiduralspaceareviewofavailabletechnologies
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