Accuracy of Epidural Pressure Waveform Analysis for Determining the Correct Placement of Epidural Catheter in Elderly Patients-An Observational Analytical Study

This observational analytical study evaluates the diagnostic accuracy of Epidural Pressure Waveform Analysis using an arterial pressure transducer for confirming the correct placement of an epidural catheter in elderly patients of age 60 years and above undergoing surgery. The study is designed to compare the Epidural Pressure Waveform Analysis method against the dermatomal testing of cold sensation. A total of 193 elderly patients will be enrolled in the study. The design employs blinding, where one anesthesiologist performs the cold sponge test and a second anesthesiologist, blinded to the results of the cold test, performs the waveform analysis. The primary outcome is to determine the sensitivity and specificity of epidural waveform analysis in identifying correct catheter placement. Secondary outcomes include finding the positive predictive value and negative predictive value, evaluating the accuracy with respect to thoracic and lumbar epidural placement, determining the amount of saline required to obtain the epidural pressure waveforms, measuring the number of epidural revision rates, and finding the association between mean arterial pressure, plethysmographic variability index, and the presence or absence of the epidural waveform. The study aims to determine if the cost-effective and objective Epidural Pressure Waveform Analysis method is a reliable diagnostic tool for confirming epidural catheter placement in the elderly population, where existing literature on this method is lacking for this age group.