Confirming identification of the epidural space: a systematic review of electric stimulation, pressure waveform analysis, and ultrasound and a meta-analysis of diagnostic accuracy in acute pain
Authors' conclusion
Electric stimulation and pressure waveform analysis seem clinically useful, although they must be interpreted cautiously.
Study context
- Population
- Adults with acute pain undergoing epidural placement with conventional Touhy needles and epidural catheters
- Comparison
- Electric stimulation vs Pressure waveform analysis vs Ultrasound
- Outcome
- Diagnostic accuracy (sensitivity and specificity) for confirming identification of the epidural space
Methodological detailsQUADAS-2 risk of bias assessment, PubMed searched between May and August 2022, Sensitivity and specificity estimated by univariate logistic regression (electric stimulation, pressure analysis) and pooling of similar studies (ultrasound)
- QUADAS-2 risk of bias assessment
- PubMed searched between May and August 2022
- Sensitivity and specificity estimated by univariate logistic regression (electric stimulation, pressure analysis) and pooling of similar studies (ultrasound)
Pooled result
As reported in the abstract
Diagnostic accuracy for confirming epidural space identification
- Ultrasound (B-mode, M-mode, doppler) may be challenging; data still limited
- Significant risk of bias; estimates to be interpreted with caution
Further pooled results
Limitations of methods
- Electric stimulation requires wire-reinforced catheters and adequate nerve stimulator, does not reliably identify intravascular placement, and is affected by local anaesthetics
- Pressure waveform analysis unaffected by local anaesthetics but does not identify intravascular or intrathecal catheters
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Confirming identification of the epidural space: a systematic review of electric stimulation, pressure waveform analysis, and ultrasound and a meta-analysis of diagnostic accuracy in acute pain. J Clin Monit Comput. Published 22 July 2023. doi:10.
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