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The Evolution of Epidural Infusion Devices in Obstetric Anesthesia
Abstract Number: F 49
Abstract Type: Case Report/Case Series
Advancements in modern pumps have made epidural analgesia better and safer for patients. Our paper reviews the development of epidural infusion devices into modern anesthesia practice. By 1949, Flowers, et al. had shown the efficacy of epidural infusion via catheter for labor analgesia and cesarean section. The catheter was manually bolused--a labor intensive process more prone to complications ranging from total spinal to contamination. Crude continuous drip infusions failed due to the high resistance of the epidural catheter and variations in drip rate with changes in patient position. The need for mechanical devices to deliver consistent epidural infusions was recognized.
In the 1950s, three designs were patented: the drip rate, syringe, and volumetric pump. The first reported use of a mechanical epidural infusion pump was in 1963. Cox and Spoerel utilized an electric motor-driven syringe pump by Harvard Inst Corp with a set speed of 1.27 ml/min. A mechanical timing device attached to the pump set the syringe in motion for 1 to 60 minutes every hour. In 1970, Spoerel further detailed the design of syringe and volumetric pumps for continuous or intermittent epidural infusions, and found intermittent devices superior for obstetrical analgesia. Advancements in infusion pumps continued throughout the 1970's with multiple patents improving on reliability, pressure monitoring, air sensors and bolus options. The last prompted the development of patient controlled epidural analgesia(PCEA).
The origins of PCEA started with IV-PCA in the 1960's when Roe demonstrated that intermittent boluses of IV morphine were more effective than IM injections. In 1971 Sechzer, the inventor of the IV-PCA, demonstrated the first mechanical IV-PCA system. Subsequently, Evans described a prototype PCA syringe pump used for IV opioid administration during labor which developed into the first commercial PCA, the "Cardiff Palliator", in 1976. Seeing the advantages of IV-PCA analgesia in labor, Dr. Gambling developed the first system of PCEA for labor in 1988 using an IVAC 530 pump and custom control device. The IVAC 530 is a non-volumetric peristaltic pump controlled by an optoelectric drip counter. While crude compared to modern designs because this pump could not account for drip size variation or detect distal occlusions, this design did establish the framework to the successful PCEA pumps used today.
The evolution of epidural infusion pump design since the early syringe drivers of Cox and Spoerel has contributed greatly to patient safety and accuracy of drug delivery. Our study acknowledges the contributions of the visionaries who brought this device into our everyday practice.
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2. Can Anaesth Soc J 1964; 11:72–82
3. Can Anaesth Soc J 1970; 17:37–51
4. Arch Surg 1963; 87:912–5
5. Anesth. Analg. 1971; 50:1–10
6. Lancet 1976; 1:17–8
7. Can J Anaesth 1988; 35:249–54
8. West. J. Med. 1985; 143:329–32