Sensitivity and specificity of waveform analysis for assessing postoperative epidural function - 17/01/22
, Gregory Klar, MD a , Wilma M. Hopman, MA b, c , Leopoldo Muniz da Silva, PhD d , Andrew G. Day, MSc b, c , Rachel Phelan, MSc a , Michael McMullen, MD a , Kai Chen, MD a , Rodrigo Moreira e Lima, PhD a , Glenio B. Mizubuti, MD a, ⁎ Abstract |
Study objectives |
To characterize the accuracy of epidural waveform analysis (EWA) in assessing the functionality of thoracic epidural catheters in the immediate postoperative period (primary objective), and to determine the inter-rater reliability between EWA waveform observers (secondary outcome).
Design |
Single center, prospective diagnostic accuracy cohort study.
Setting |
Post-anesthetic care unit of a university teaching hospital.
Patients |
84 adult patients undergoing elective thoracic, gynecologic, vascular, urologic, or general surgery with preoperative placement of a thoracic epidural catheter for perioperative analgesia.
Interventions |
EWA tracings were video recorded in the immediate postoperative period through the epidural catheter in the post-anesthetic care unit.
Measurements |
Postoperative EWA tracings were compared with clinical assessments of the sensory block to ice produced by epidural local anesthetic in the immediate postoperative period. Additionally, intra-class correlation analysis of agreement between 3 independent (and blinded) EWA waveform observers was carried out.
Results |
Among 80 patients with thoracic epidurals who completed the study protocol, 73 demonstrated postoperative functional epidurals with sensory block to ice and 7 demonstrated non-functional epidurals. EWA yielded 65 true positives, 6 true negatives, 8 false negatives, and 1 false positive. Postoperative EWA sensitivity, specificity, positive predictive value and negative predictive value, along with the 95% confidence intervals (CI) were 89% (79–95%), 86% (42–100%), 98% (92–100%), and 43% (18–71%) respectively. Intra-class correlation between waveform assessors was 0.870 (95% CI 0.818–0.910, p < 0.001).
Conclusions |
EWA is useful in assessing the position of thoracic epidural catheters in the immediate postoperative period, demonstrating high sensitivity and specificity as well as robust inter-rater reliability. For patients in whom sensory block to ice cannot be reliably assessed postoperatively, EWA may provide a useful adjunct for assessing epidural functionality.
Le texte complet de cet article est disponible en PDF.Highlights |
• | EWA is useful in assessing position of thoracic epidural catheters postoperatively. |
• | Postoperative EWA sensitivity and specificity were 89% and 86%, respectively. |
• | Test positive and negative predictive values were 98%, and 43%, respectively. |
• | Intra-class correlation between independent waveform assessors was 0.870. |
• | Postoperative EWA is useful when sensory block to ice cannot be reliably assessed. |
Keywords : Epidural assessment, Epidural failure, Epidural waveform analysis, Neuraxial analgesia, Postoperative pain management, Thoracic epidural
Plan
Vol 77
Article 110630- mai 2022 Retour au numéro
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