Use of the CompuFlo? systemto identify the epidural spacein obstetric-gynecological area.A single-center retrospective study

摘要

Although epidural anesthesia (EA) is frequently used,the success rate is different and complications, as accidental dural puncture (ADP), may occur due to incorrect needle placement.1 This is mainly observed with thecommonly used technique of “Loss-Of-Resistance” atthe pressure exerted by the anesthesiologist’s thumb onthe plunger of a syringe containing saline, or air, whichis injected through an epidural “Tuohy” needle. Pressurecontrol during injection of local anesthetics has recentlybeen studied both on simulator and in large a review ofthe literature concerning peripheral blocks.2, 3 To limitcomplications, a new device is being proposed (CompuFlo? Epidural System, CompuFlo?, Milestone Scientific, Livingston, NJ, USA).4 It is a computer-controlleddrug-delivery system, able to measure the pressure atthe tip of the needle during its progression through thetissues. The needle is connected via an arterial line extension tubing to a saline-filled syringe, whose plungeris controlled with real time feedback by CompuFlo?.Thanks to the fluid column through the epidural needle,CompuFlo? measures pressures obtained at the injection site four times a second, displaying a pressure/timecurve on a dedicated digital monitor. During insertion,a continuous acoustic signal produced by CompuFlo?guides the operator too: when the needle runs into higher density tissues (i.e. in ligamenta) and the pressureat the injection site rises, the device produces a highertone; when the pressure suddenly decreases (i.e. in theepidural space), a sudden fall in the tone of the audiooutput is clearly adudible.