STUDY OF TIME TO REACH THE EPIDURAL SPACE AND FAILED EPIDURAL ANALGESIA

Abstract

Background- Adequate pain relief during the perioperative period is the main part of balanced anaesthesia. Thoracic epidural anaesthesia has been a cornerstone in the perioperative care after thoracic and major abdominal surgery providing most effective analgesia.

Aims- - the main aim of our study is ‘’To compare the efficacy of” Episure” AutoDetect syringe and Glass syringe using loss of resistance technique with “Air “for identification of lower thoracic epidural space’’.

Methods and materials- This prospective, randomized, parallel group double-blinded study conducted in the Department of Anaesthesiology, Chengalpattu Government Medical College and Hospital, Chengalpattu for period of one year from April 2019 to April 2020.

The study population has been chosen from patients admitted for surgery in the Department of General Surgery and from the Department of Orthopedics. Sample size is 82, each group consists of 41 participants. After ethical committee approval and informed written consent among the study population, they were allocated randomly into two groups by picking odd or even numbers. Group A [n=41] epidural space identified using Episure Auto Detect Syringe, Group B [n=41] epidural space identified using Glass Syringe. The categorical variables of them were described in terms of percentages and compared between them by an appropriate non parametric test namely χ2 (Chi-square) test. The above said activities were carried by the statistical package namely IBM SPSS Statistics-20. The P-values less than or equal to 0.05 (p≤0.05) were considered as statistically significant.

Results- males of both groups were 68.3% and the females of both groups were 31.7%. Males forms a higher percentage of participation in both groups than female. Mean height and mean weight was not statically significant. The mean depth to Epidural space of Group A was 4.3±0.5 cm and Group B was 4.4±0.5 cm. the incidence of successful epidural space identification in first attempt was more (39 patients) with Group A [Episure syringe] when compared to the Group B [Glass syringe] (31 patients) and two groups were statistically significant in respect of number of attempts (P<0.05). the mean time to reach epidural space for Group A was 27.4±8.6 seconds and Group B was 40.6±15.4 secs. The difference between the two groups was statistically significant (P<0.001). Hence the time to reach the epidural space was found to be significantly lesser in Group A [Episure AutoDetect Syringe]. No incidence of failed epidural analgesia in Group A (Episure Auto Detect syringe). There were 6 case of failed analgesia present in Group B (Glass syringe) and the result is found to be statistically significant.

Conclusion- The spring-loaded syringe provides both subjective and objective confirmation of epidural space by the depression of plunger. This objective confirmation of epidural space prevents the overshooting and thereby decreases the incidence of accidental dural puncture by the beginners. Episure Auto Detect syringe allows reliable and quicker identification of the epidural space in lower thoracic epidural technique as compared to use of glass syringe. There was no incidence of inadvertent dural puncture or failed analgesia with the Episure Auto Detect syringe technique.