Objective real-time epidural pressure measurement using the CompuFlo® device, a mono-center observational study.

Background: Epidural anesthesia (EA) is particularly relevant in the cases of expected intense and lasting postoperative pain. Yet, this technique is considered challenging in young children because of the difficulty in perceiving the loss of resistance (LOR) required to detect the epidural space. The CompuFlo® device is a computerized injection pump that accurately detects real-time pressure at the tip of a needle. This prospective observational study aimed to describe pressure levels during EA in children. Therefore, we hypothesized that pressures would be lower in smaller children.

Methods: All surgical patients requiring an EA were eligible for inclusion. During the procedure, pressures before LOR were measured in real-time using both modes (manual and automatic) of the CompuFlo® device. Factors that may influence pressure levels, such as weight, were also investigated.

Results: We analyzed the last pressures just before LOR during 56 procedures performed on 47 patients. Median pressures (quartiles) were 174 (120; 314) mmHg. The pressure before LOR was correlated to the weight (r = 0.61 in the automatic group), with values significantly lower in the group of children under 5 kg (p = 0.02) compared to the other weight groups.

Conclusion: The CompuFlo® device allowed a pressure measurement prior to obtaining LOR during EA catheter placement in children. Younger children appear to have lower pressure levels. This could partly explain the difficulty in detecting the epidural space in infants. This observational study describes initial results that could be used as a basis for future hypotheses.

Registration: ClinicalTrial.gov, NCT03672526.