Pressure Waveforms to Assess Epidural Placement: Is there a Role on Delivery Suite?

(Anaesthesia. 2017;72:811–825) Reliable and timely administration of epidural analgesia during labor is a major goal for both parturients and anesthesiologists. Although maternal anatomy sometimes contributes to epidural failures, the incorrect placement of the epidural catheter is the major contributor to failed epidural labor analgesia. The “loss of resistance” technique is the most common method used to identify the epidural space, but it lacks specificity as advancement through other tissues may also provide what is often referred to as a “false loss of resistance.” Ultrasound can aid with insertion of the needle during epidural placement by calculating an estimated distance to the epidural space and guiding the correct puncture site and needle angulation. Dural puncture epidural, where a dural perforation is created with a spinal needle placed through an epidural needle to ensure the correct positioning of the epidural needle-tip in the epidural space, has been shown in some studies to provide better analgesia. Epidural test doses are also used to ensure successful epidural placement in obstetrics, but the lack of real-time feedback limits the usefulness of this method. Although CT fluoroscopy is useful for the placement and confirmation of epidural catheter tip position, the equipment and radiation exposure considerations do not allow its use in obstetrics.
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Mechanisms, Equipment, Hazards Source Type: research