Clinical, economic and environmental evaluation of CoolStick compared to ethyl chloride to assess neuraxial sensory block level for caesarean delivery: a prospective observational study

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia Pub Date : 2025-03-05 DOI:10.1016/j.ijoa.2025.104349

H. Bykar, R. Craig, J.E. O’Carroll, S. Bampoe, P.M. Odor

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引用次数: 0

Abstract

Background

CoolStick is a steel cylindrical device designed to be refrigerated and provide a sustainable, cost efficient alternative to vapo-coolant sprays when assessing cold sensation of neuraxial anaesthesia. We compared sensory block level testing with ethyl chloride and CoolSticks. We aimed to investigate the clinical efficacy, economic, environmental and practical considerations of CoolStick use.

Methods

Assessments of sensory block height were made using ethyl chloride and CoolStick prior to caesarean delivery according to a standardised protocol. Block height to cold sensation was compared to light touch using cotton wool. Patient feedback was collected to determine ease of discrimination between testing methods. Statistical analysis of concordance were assessed using the Kappa test, and depicted using Bland-Altman plots.

Results

50 patients undergoing caesarean delivery were included. Block assessment using ethyl chloride and CoolStick showed good agreement bilaterally (κ = 0.77, 0.63) and good concordance on Bland-Altman plot. Block level agreement with cotton wool was poor with both CoolStick (κ = 0.086, κ = 0.044) and ethyl chloride (κ = 0.076, κ = 0.035). Switching to routine CoolStick use in a hospital with 5500 deliveries may save £9,500 annually while preventing 229.32 kg of potentially unnecessary CO₂ equivalent emissions in the first year, and 238.4 kg each year thereafter.

Conclusions

CoolStick offers clinical equivalency to ethyl chloride for sensory block level assessment. Switching to using CoolStick may represent a positive economic and environmental movement.

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与乙基氯相比，CoolStick用于评估剖宫产神经轴感觉阻滞水平的临床、经济和环境评价：一项前瞻性观察研究

coolstick是一种钢制圆柱形装置，用于冷藏，在评估轴向麻醉的冷感觉时，它提供了一种可持续的、经济高效的蒸汽冷却剂喷雾替代方案。我们比较了感官块水平测试与乙基氯和CoolSticks。我们旨在探讨CoolStick使用的临床疗效、经济、环境和实际考虑。方法在剖宫产前采用乙氯和CoolStick对感觉阻滞高度进行评估。用棉絮比较块高度对冷感的影响。收集患者反馈以确定检测方法之间的区别。一致性的统计分析使用Kappa检验进行评估，并使用Bland-Altman图进行描述。结果入选剖宫产患者50例。使用乙基氯和CoolStick进行分组评估，结果显示双方具有良好的一致性（κ = 0.77, 0.63）， Bland-Altman图具有良好的一致性。CoolStick （κ = 0.086, κ = 0.044）和乙基氯（κ = 0.076, κ = 0.035）与棉絮的块水平一致性较差。在一家有5500名分娩的医院，改用CoolStick的常规使用每年可以节省9500英镑，同时在第一年减少229.32公斤潜在不必要的二氧化碳当量排放，此后每年减少238.4公斤。结论scoolstick与乙氯具有临床等效性，可用于感觉阻滞水平评估。改用CoolStick可能是一种积极的经济和环境运动。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International journal of obstetric anesthesia 医学-妇产科学

CiteScore

4.70

自引率

7.10%

发文量

285

审稿时长

58 days

期刊介绍： The International Journal of Obstetric Anesthesia is the only journal publishing original articles devoted exclusively to obstetric anesthesia and bringing together all three of its principal components; anesthesia care for operative delivery and the perioperative period, pain relief in labour and care of the critically ill obstetric patient. • Original research (both clinical and laboratory), short reports and case reports will be considered. • The journal also publishes invited review articles and debates on topical and controversial subjects in the area of obstetric anesthesia. • Articles on related topics such as perinatal physiology and pharmacology and all subjects of importance to obstetric anaesthetists/anesthesiologists are also welcome. The journal is peer-reviewed by international experts. Scholarship is stressed to include the focus on discovery, application of knowledge across fields, and informing the medical community. Through the peer-review process, we hope to attest to the quality of scholarships and guide the Journal to extend and transform knowledge in this important and expanding area.