self compressing epidural syringe

8/8/2019 Self Compressing Epidural Syringe

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Modification of Loss of

Resistance Syringe forEasier Identification ofEpidural Space

Dr. Maulik R. Mehta

D.A., DNB Anaesthesia student

Dr. Mukesh Vakil

M.D. consultant and HOD

Dr. Suresh Barot

M.D. consultant

Dr. Himanshu Shah


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Epidural anaesthesia

IntroductionAcceptance across the globeSupported by many studies in Anaesthesiology

and Pain Medicine, establishing its effectiveness,

Now developments are in direction of improving

the technique for,

better precision,

easier technique,

fewer side effects.


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Detection of the

epidural spaceLoss Of Resistance Technique

(LORT)

Dogliotti's principle1:

In epidural anaesthesia, the

change of pressure from the

1.British Journal of Anaesthesia 22 (3): 150155.


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Difficulties with LORT

Even though LORT is widely used since decades

some problems are encountered with technique

like


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Subjective

feel

To appreciateL.O.R. when

pressure appliedon the plunger byoperator's thumb.

Anesth 2004;100, A72 ,BJA 44 (1): 122.


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Need of specialized syringe for LOR extremely low friction coefficient should move very smoothly


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Saline Air


Debate regarding which medium touse2

2, AANA J. 2003 Dec;71(6):449-53


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compressibility ofair

Better Subjectivefeel

Safer 3

No injection of airin a blood vessel,

No

pneumocephalus, No patchy andinadequateanalgesia

Saline Air


3, Anesth. 1997 Jan-Feb;22(1):3-15


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Lack of precision with one hand


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To overcome such

disadvantages, we modifiedthe LOR syringe so that the

new method retains all theadvantages of the loss of

resistance technique whilst inaddition it nullifies itsdisadvantages.


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Conversion of a regular LOR

syringe to self compressingspace detectorEquipments:

1. An elastic band which can just be acut end of a surgical glove as shownin the picture, and

2. A regular LOR syringe.


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Modification

As shown below make loop of band around LORsyringe.


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Modification

Stretch the loose end of the loop and wrap itover the plunger.


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Modification

The Modified LOR syringe is ready to locateepidural space.


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Identification TechniqueClick to edit Master text styles

Second level Third level

Fourth level Fifth level


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Advantages

Modification eliminates the need to

apply pressure on the plunger

use of both hands while advancing

slowly.

Entering the epidural space,

Plungers automatically compression


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Advantages continued.

Use of both hands provides,

Better precision,

Great control, Solid stability and Higher confidence.

Making the technique more,

Reliable, Quicker and Safer.


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Constant force on the plunger,

automatically compresses when the epidural

needle enters the epidural space,

Eliminates the subjective "feel"

required with standard LOR

syringes.

Reduced chances of creating false


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Air Vs Saline: no subjective feel is required

technically saline is as good as air. By avoiding air we can avoid all

complications related to it like, patchyblock, risk of air embolism, etc


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Scope for reducing the Cost:

Instead of LOR syringe, regular syringewith elastic band,

clinical studies required.

Till date no study done.


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Pilot Study

10 cases in each group:1. Group R - Regular LOR syringe

2. Group M - Modified LOR syringe

Data analyzed:

. Ease of technique (scale of 1 to 10),

1 = extremely difficult to 10 =extremely easy

. Time required for identification of space,
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Pilot Study

10 cases in each group:1. Group R - Regular LOR syringe

2. Group M - Modified LOR syringe

Data analyzed:

. Ease of technique (scale of 1 to 10),

1 = extremely difficult to 10 =extremely easy

. Time required for identification of space,

Intravascular catheter, Inadvertent dural puncture,

Failed block


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Results

Group R Group M

Ease of technique

(scale of 1 to 10)Mean S.D. 5.4 2.4 8.1 0.8

Mean Time required foridentification of space

(Sec.) S.D. 56 35

27 9.7

Complication(s)encountered 1 0


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Conclusion

By using material readily available inOperation Theater we can modify the LORto a self compressing epidural locator

syringe which provides a reliable, quickerand safer technique for identification ofthe epidural space.

Larger study required

In addition to being useful in difficultepidurals, the technique would also be an

excellent teaching aid, especially for


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Newer developments in field ofepidural anaesthesia are in direction of

developing similar syringes that maycome to market soon

But why to wait, if can modify syringe

with materials readily available in OT


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Newer developments in field ofepidural anaesthesia are in direction of

developing similar syringes that maycome to market soon

But why to wait, if can modify syringe

with materials readily available in OT

self compressing epidural syringe

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