title: Clinical results with the acoustic puncture assist device, a new acoustic device to identify the epidural space.
abstract: Sixty patients scheduled for lumbar epidural anesthesia were included in a study in which we evaluated the efficacy of localizing the epidural space by means of an acoustic signal. A prototype of an acoustic puncture assist device, connected to the epidural needle by an extension tube, generated the pressure needed to perform the epidural puncture and translated this pressure into corresponding acoustic and visible signals. The device frees the anesthesiologist to handle the epidural needle with both hands and to detect the epidural space by means of these signals. In all 60 patients (100%), the epidural space was successfully located by using the acoustic signal. In all cases, this was confirmed by the pressure measurement, which proved to be a reliable indicator for correct identification of the epidural space. We conclude that it is possible to locate the epidural space by means of the acoustic puncture assist device. The method proved to be reliable, safe, and simple in this study. The benefits of this new epidural puncture technique include better needle control, teaching, control of correct catheter placement, and documentation. The last can be an important adjunct to anesthesia practice.
  
  
  CONCLUSIONS
  The authors demonstrate that it is possible to identify the epidural space by an acoustic and visible signal. An experimental setup constructed for this purpose makes the epidural puncture procedure audible and visible.
authors.affiliation: Departments of *Anesthesiology and Pain Therapy and †Clinical Physics, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands.
authors.forename: Timo J
authors.initials: TJ
authors.lastname: Lechner
authors.forename: Maarten G
authors.initials: MG
authors.lastname: van Wijk
authors.forename: Ad J
authors.initials: AJ
authors.lastname: Maas
authors.forename: Frank R
authors.initials: FR
authors.lastname: van Dorsten
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Drost
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Langenberg
authors.forename: Leo J
authors.initials: LJ
authors.lastname: Teunissen
authors.forename: Paul H
authors.initials: PH
authors.lastname: Cornelissen
authors.forename: Jan
authors.initials: J
authors.lastname: van Niekerk
mesh_terms: D000161:Acoustic Stimulation; D000368:Aged; D000767:Anesthesia, Epidural / Q000379:methods*; D004824:Epidural Space / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010147:Pain Measurement