ABSTRACT

BACKGROUND AND AIMS: EpisureTMAutoDetectTM syringe (EAS), a spring-loaded syringe, is a new loss-of resistance (LOR) syringe with an internal compression spring that applies constant pressure on the plunger used to indentify epidural space. In this study, we compared the performance of EAS with that of glass syringe when used to identify epidural space using LOR technique with saline for lower thoracic epidurals in abdominal surgeries.

METHOD: After getting ethical committee approval & informed consent, a total of 120 patients of age between 18 – 60 yrs, ASA I-II requiring abdominal surgeries & post- operative analgesia were included and randomized into 2 groups with 60 patients in each group. Group I (EAS) receiving Lower Thoracic Epidurals with EpisureTM AutoDetectTM spring-loaded syringe & Group II (GS) with Glass syringe. Patient demographic data, Depth to epidural space (cm), Number of attempts, Time to locate epidural space (sec), Inadvertent dural puncture, Ease of catheter placement & Failed epidural analgesia are the parameters noted.

RESULTS: There were no differences in patient demographics, or depth to the epidural space between the two groups. There were incidence of failed blocks in the glass syringe group and none in the EAS group. Similarly, there were inadvertent dural punctures in the glass syringe group while less in the EAS group which is statistically significant (p<0.01). When epidural was identified in one attempt, the time needed to identify epidural was quicker with EAS (p<0.01).

DISCUSSION: The study findings are consistent with the literature evidence from previous studies. However, previous studies have been done using lumbar epidurals only and not with lower thoracic epidurals. Hence there is a need for this study. CONCLUSION: Using EAS allowed reliable and quick identification of the epidural space in lower thoracic level. There were no failed blocks and less inadvertent dural punctures with the EAS in this study. It is also a best learning tool in the hands of Anaesthetic residents.