Comparative study of Episure™ AutoDetect™ syringe versus glass syringe for identification of epidural space in lower thoracic epidural.

Background And Aims: Episure™ AutoDetect™ syringe (EAS), a spring-loaded syringe, is a new loss-of-resistance syringe used to identify epidural space. It has an advantage of subjective and objective confirmation in identifying epidural space over glass syringe (GS) for beginners. We compared the performance of EAS with that of GS for identifying epidural space in lower thoracic epidurals.

Methods: A total of 120 American Society of Anesthesiolgists I-II patients aged 18-60 years requiring lower thoracic epidural analgesia for surgery were randomised into Group I (EAS): Epidural identified using EAS and Group II (GS) epidural identified with GS. Patient demographic data, depth to epidural space (cm), number of attempts, time to locate epidural space (s), inadvertent dural puncture and failed epidural analgesia were the parameters noted.

Results: There were no differences in patient demographics or depth to the epidural space between the two groups. There were five failed blocks in the GS group and none in the EAS group (P = 0.0287). Similarly, there were five inadvertent dural punctures in the GS group and none in the EAS group (P = 0.0287). When epidural was identified in fewer attempts, the time needed to identify epidural space was quicker with EAS (P = 0.0012).

Conclusion: Using EAS allowed reliable and quick 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 blocks with the EAS.