[Localization of lumbar epidural space by loss of resistance and using the Episensor: a comparative study]

Since the existence of negative pressure in the epidural space was reported, its technique of localization has undergone changes directed to improve objectivity, reliability and safety. The aim of the present study was to evaluate a new electronic divide to localize the epidural space, i.e. the Episensor (Palex, Spain). To this end, 71 patients, both males and females, undergoing elective urological surgery and in whom catheterization of the lumbar epidural space had been planned, were prospectively evaluated and randomly assigned to two homogeneous groups. In group I (n = 35) the epidural space was localized by the classical technique of loss of resistance, while in group II the Episensor was used. In both groups several technical parameters, the qualification of the operator and the complications of the procedure were evaluated. There were no significant differences between both groups regarding the quality of epidural blockade or the subjective technical difficulty of the operator. The incidence of complications of the technique of puncture was significantly higher in group II (p less than 0.05); the most common were dura mater puncture in 13 group II patients and in one group I patient (p less than 0.001). There was no correlation between the qualification of the operator and the development of complications. It was concluded that the use of Episensor to localize lumbar epidural space did not improve the effectiveness of blockade but increased the iatrogenic effects of the puncture. Our lack of experience with this new technique and the low negative pressure of lumbar epidural space might have been the causes of the poor results, that we consider as initial in the evaluation of this new method.