///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

The Gravity Flow Technique for Epidurals: Use of the Internet to Disseminate an Instructional Video

Abstract Number: 41
Abstract Type: Original Research

Gilbert J Grant MD1

The Gravity Flow Technique for Epidurals: Use of the Internet to Disseminate an Instructional Video

The gravity flow technique for administration of epidural analgesia or anesthesia was originally described by Cohen et al (1,2). They noted that the gravity flow technique has two distinct advantages compared to a conventional epidural approach: 1) It provides indirect visual confirmation that the tip of the epidural needle is indeed located in the epidural space and 2) It enhances the safety of administering analgesic/anesthetic medication through the epidural needle.

In 2002, a few members of our department began to use the gravity flow technique to administer epidural analgesia and anesthesia to parturients. Impressed with its efficacy, these practitioners encouraged their colleagues to adopt the technique as well, with limited success. The reluctance of others to try the new technique may have been related to natural human reticence to change (3), and/or to the perception that the gravity flow technique is a complicated, time-consuming procedure. In fact, once one has gained a modicum of experience with it, one realizes that the gravity flow technique is quite simple and straightforward to perform.

Like all procedures, the gravity flow technique is best described visually, rather than verbally or in writing. We thus decided to produce a brief (ten minute) instructional video to explain the gravity flow technique in a step-by-step manner. We uploaded the video to popular websites (youtube.com, video.google.com, liveleak.com) using easily identifiable tags (epidural, technique, instructional), so that it is readily accessible to anyone interested in learning about it, at their discretion. Feedback regarding this instructional video from members of our department has been uniformly positive. Residents, who are first exposed to the gravity flow technique during their obstetric anesthesia rotation, now learn about it through the video prior to the start of their rotation. We are hopeful that through the internet we will be able to disseminate information regarding the gravity flow technique to reach other interested individuals beyond our institution. We are currently contemplating producing other educational videos.

1.Cohen S, Amar D, Nagashima H. Extradural block in obstetric patients: review of experience with gravity administration. Acta Anaesthesiol Scand. 1991;35:676-9.

2.Cohen S, Amar D. Epidural block for obstetrics: comparison of bolus injection of local anesthetic with gravity flow technique. J Clin Anesth. 1997;9:623-8.

3.Grant GJ, Grant AH, Lockwood CJ. Simpson, Semmelweis, and transformational change. Obstet Gynecol. 2005;106(2):384-7.

SOAP 2009