Risk reduction in epidural procedures

January 29, 2014, Bournemouth University
L-R: Neil Vaughan, Professor Michael Wee and Dr Venky Dubey.

Thousands of epidurals are performed by doctors every year. The procedure is commonly used for pain-relief during childbirth, the treatment of chronic back pain or as a means to provide anaesthesia during operations.

Inserting an needle into the spine requires great skill and extensive training, and can be challenging even for experienced anaesthetists. Obesity poses further difficulties, due to technical problems locating the epidural space.

Currently around one in every 100 epidural procedures lead to a post-dural puncture headache, one in 6,700 cause a neurological injury and approximately one in every 80,000 will result in permanent harm.

Professor Michael Wee from Poole Hospital explains: "One of the most common problems after an epidural for labour is what is called a dural tap, where the epidural needle punctures the covering of the and causes leakage of spinal fluid. This may cause a debilitating headache for the mother and prevent her from caring for and enjoying her newborn. There is a need to provide precise training in a delicate clinical procedure which has potentially devastating effects when things go wrong."

Medical devices being developed by Bournemouth University and Poole Hospital will help doctors to carry out the procedure – and reduce the risk for patients.

"I decided to team up with BU's School of Design, Engineering & Computing as it has the necessary expertise and skills in developing the epidural simulator," says Professor Wee. The project is being led by BU's Dr Venky Dubey, alongside PhD student Neil Vaughan, Professor Wee and Dr Richard Isaacs, also from Poole Hospital.

Dr Dubey believes they can dramatically reduce the risks associated with the procedure by providing training on a state of the art epidural simulator, thereby reducing the learning curve.

He says: "You don't know with each patient how far the epidural needle has to go. It varies from person to person and it is very difficult to tell.

"It is all based on training and experience – when doctors are inserting the needle into the spine, they know they have reached the epidural space as there is a loss of resistance. But even for an experienced anaesthetist it is quite difficult, because different people have different body shapes and sizes. Our proposed epidural simulator will allow us to simulate all types of body conditions to allow doctors to practise the technique."

The team has developed software which uses information such as a patient's height, weight and body shape and integrates it with ultrasound and MRI scans to predict where their epidural space will be.

Dr Dubey adds: "The ultimate aim is to have a novel epidural simulator which accurately replicates individual characteristics and gives doctors experience of the procedure without them having to practise on a patient."

The devices have been tested on porcine cadavers and clinical trials on patients have looked at the relationship between Body Mass Index (BMI) and the epidural ligaments pressure.

The trials found that as patient BMI increases, the epidural ligamental pressure decreases; the patients with the lowest BMI had the highest mean pressure. This is a new and important finding.

The project has already received international attention, and recently won the Institution of Engineering and Technology (IET) Innovation Award in the Information Technology category. It has also been shortlisted for a number of prestigious awards – including in the Technology and IT to Improve Patient Safety category at the National Patient Safety Awards 2013, the American iShow, and the International Student Design Showcase 2013 – which it won.

It was also the only UK-based project at the American Society of Mechanical Engineers (ASME) Innovation Showcase, competing against Ivy League universities.

"Nobody has done anything like this before – there's quite a buzz about it," says Dr Dubey. The team eventually hopes to commercialise the simulator and industry partners are interested in the work.

Explore further: Epidural simulator will help reduce risk of harm to patients

Related Stories

Epidural simulator will help reduce risk of harm to patients

April 22, 2013
The simulator has been developed by Bournemouth University and Poole Hospital, and will help train doctors to perform epidurals. It has already been shortlisted for several prestigious awards.

Epidural during/Post spine surgery gives better outcomes

July 17, 2013
(HealthDay)—In patients undergoing reconstructive spine surgery, combined epidural and general anesthesia results in better pain control and other outcomes compared with general anesthesia plus narcotics, according to a ...

Post-op hematoma incidence similar for decompression types

December 17, 2013
(HealthDay)—For patients undergoing decompression for degenerative stenosis, the incidence of epidural hematoma is similar for different surgical approaches; however, there is a tendency toward increased postoperative hematoma ...

Combo treatment might beat epidural to ease labor, study says

March 5, 2013
(HealthDay)—In the first stage of labor, a combined spinal-epidural technique provides faster and better pain relief compared to traditional epidural pain relief, a new study suggests.

Bolus epidural fentanyl cuts post-spinal decompression pain

September 7, 2012
(HealthDay)—Intraoperative bolus epidural fentanyl is effective at alleviating early postoperative pain after lumbar canal decompression, according to a study published online Aug. 27 in The Spine Journal.

Language barrier blocks epidural use in childbirth: study

October 14, 2012
(HealthDay)—Language barriers may help explain why Hispanic women in the United States are less likely than white women to receive an epidural for pain relief during childbirth, a new study finds.

Recommended for you

Best of Last Year—The top Medical Xpress articles of 2017

December 20, 2017
It was a good year for medical research as a team at the German center for Neurodegenerative Diseases, Magdeburg, found that dancing can reverse the signs of aging in the brain. Any exercise helps, the team found, but dancing ...

Pickled in 'cognac', Chopin's heart gives up its secrets

November 26, 2017
The heart of Frederic Chopin, among the world's most cherished musical virtuosos, may finally have given up the cause of his untimely death.

Sugar industry withheld evidence of sucrose's health effects nearly 50 years ago

November 21, 2017
A U.S. sugar industry trade group appears to have pulled the plug on a study that was producing animal evidence linking sucrose to disease nearly 50 years ago, researchers argue in a paper publishing on November 21 in the ...

Female researchers pay more attention to sex and gender in medicine

November 7, 2017
When women participate in a medical research paper, that research is more likely to take into account the differences between the way men and women react to diseases and treatments, according to a new study by Stanford researchers.

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.