RESUMEN
BACKGROUND: The CompuFlo® epidural system has been recently introduced and validated as an objective and sensible tool to detect the epidural space. We aimed to verify whether the high sensitivity of the instrument may help the anesthesiologist to identify the epidural space very early, limiting the extension of the Tuohy needle into the epidural space. METHODS: In this prospective, simulation study, we evaluated the Tuohy needle extension through a simulated ligamentum flavum during the epidural procedure performed by 52 expert anesthesiologists by using the CompuFlo® epidural instrument or their standard loss of resistance to saline technique (LORT). RESULTS: The mean (SD) needle extension length was 3.90 (3.71) mm in the standard technique group and 0.68 (0.46) mm in the CompuFlo® group (P < 000001). The extremely reduced variability of the data in the CompuFlo® group (F test 0.01) made the results obtained with this instrument highly predictable. CONCLUSIONS: Puncturing high-resistance material that simulated the ligamentum flavum, the use of CompuFlo® has determined the arrest of the needle more precociously when compared with the traditional LORT.
RESUMEN
BACKGROUND: This prospective study was designed to validate the CompuFlo® device and to assess its use in difficult epidural placement. METHODS: In the first part of the study, 30 parturients requesting labor epidural analgesia were recruited. The block was performed by an expert anesthesiologist, with the Tuohy needle connected to the CompuFlo® device to evaluate the agreement between the anesthesiologist's reported sensation and the variation of pressure recorded by the CompuFlo®. In the second part of the study, 56 consecutive parturients, for whom at least two complete needle reinsertions were made by trainees during epidural placement for labor analgesia, were enrolled. CompuFlo® was used as a rescue tool for the subsequent attempt. RESULTS: In all cases epidural analgesia was successful and no complications were noted. There was a good correlation between the operator's feelings and the delta of pressure recorded by the CompuFlo®, for both identification of the ligamentum flavum and of the epidural space (Rho = 0.79; tau = 0.67). In the second part of the study, all the difficult blocks performed with the CompuFlo® were successful after a single attempt. The pressure curves of false loss-of-resistance were significantly different from the true loss-of-resistance (Pâ¯<0.0001) DISCUSSION: CompuFlo® was validated as a tool to identify the epidural space. It may also assist trainees in successful epidural placement in difficult cases.