Epidural Anesthesia

LOR Indicator Syringe

 Part 1 Clinical Problem

Part 2 Our Solution

Contents

Part 3 Our Advantage

Part 4 Study & Research

Part 5 Order Information

 01
Clinical Problem
“ As anesthesiologists are
more focused on the
postoperative treatment
and other facts, neuraxial
blockade such as epidural
anesthesia, spinal anesthesia
and caudal anesthesia are
used more frequently.
 8
Puncture Procedure
7

Interspinous ligament 4

Ligamentum Flavum 5
Supraspinous ligament 3

Subcutaneous Fat 2

Skin 1
Puncture Level

A. Skin
B. Subcutaneous Tissue
C. Supraspinous ligament
D. Interspinous ligament
E. Ligamentum flavum
F. Epidural Space
G. Subarachroid space
Puncture Maneuver
Epidural Anesthesia

“
Epidural anesthesia is one of
the most difficult procedure to
perform in anesthesiology.
The common method used for
epidural space identification is
sudden loss of resistance
(LOR) when the needle tip
passes the ligmentum flavum.
[Tielen et al]

”
Clinical Problems
14% According to the study of No. 401 Hospital of PLA, a
failure rate of 14% was found in epidural anesthesia for
laboring women.

The traditional puncture

methods are
overdependent on
experiences and skills of
anesthesiologists. High
30% Hermanides et al also investigated a number of studies on
epidural anesthesia, the overall failure rate was around 30%.
failure rate occurs in
epidural anesthesia.

The loss-of-resistance is a subjective feeling, higher failure rates

High occur with inexperienced practitioners. Even with rich experience, they
cannot have a visible judgment and repeatedly pushing action and feeling
make the puncture process more complex.
 02
Our Solution
Our Solution

LOR Indicator Syringe

Invented by Yan Qing
from No. 401 Hospital of People’s Liberation Army

(A visible “brake signal” , Balloon, let us know whether

the epidural needle arrives at the epidural space.)
LOR Indicator Syringe

1 Rubber Piston 2 Pressure-indicated Balloon

1 Plunger
1 Barrel
Operation Steps

Puncture the epidural Remove the stylet, and Push the plunger rod When the balloon gets
needle into the dense connect the prepared to the mark of 2ml to deflated promptly, it
tissue syringe with epidural make the balloon means the needle
needle tightly inflated; then, push the reaches the epidural
needle forward slowly space successfully
LOR Indicator Syringe

https://youtu.be/IYj2RnoYsRc
 03
Our Advantage
Advantage

Visibility Simple operation

LOR Indicator Syringe makes the Reduce the actions of pushing

puncture process visualized the syringe repeatedly

Safety Low resistance

The pressure in balloon is low The use of rubber plug and
and stable. its dynamic fit with the barrel
make the injection smooth

Accuracy and reliability Clinical teaching

The combination of visible indication The visibility can make the

and experience improves the teacher and student judge the
accuracy and reliability depth of the needlle tip
Popularity in Expo
Epidural Anesthesia

Popularity
LOR Indicator Syringe
Clinical Teaching
Popularity in Hospital
Epidural Anesthesia

Popularity
Clinical Operation
 04
Study & Rearch
CLINICAL PAPER
Xiaofeng Liu, E-er-dun Wang, Qing Yan, Kezhong Li. Clinical
application of a novel developed pressure bladder indicator in
lumbar epidural puncture. Journal of Clinical Anesthesia,
2015;27:543-5.
The novel developed pressure
bladder indicator was a reliable
and useful technique to conduct According to the study of
Jize et al, 368 patients
successful lumbar epidural accepted epidural anesthesia
puncture [8]. with LOR Indicator Syringe. The
successful rate of epidural catheter
placement was 100% [9].

Yan et al [8] reported

that 70 patients who
were undergoing
lumbar epidural
anesthesia or
combined spinal- RELIABLE
In the essay of Hou et al
epidural anesthesia [10], the success rate and
were enrolled to use effectiveness of puncture
LOR Indicator Syringe. and epidural catheter
The success ratio was placement to use LOR
100%. Indicator Syringe is
higher than using
traditional syringe.
Test Data
Hydrapress Measurement of Pressure-indicated The balloon pressure is
Balloon 9±2KPA. Why?
12
⚫ The low working pressure of
10
balloon might not be able to
Kpa

8 deflate the balloon when

the epidural needle reaches
6
the epidural space (false-
4 negative indication)
⚫ Extremely high working
2
pressure would make
0 balloon shriveled before the
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
needle reaches the epidural
3ml 5ml
space (false-positive
indication)
Two groups are divided in the test (30 pcs LOR Indicator Syringe per group). In the
first group, syringes are filled with 3ml normal saline, the second 5ml normal saline.
Study [1] Mackenzie I, Xu J, Cusick C, Widwinter-Morton H, Meacher H, Mollison J, et al. Acupuncture for pain relief during
induced labor in nulliparae: a randomized controlled study. Obstet Anesth Dig 2012; 32: 52-3.

[2] Pan P, Bogard T, Owen M. Incidence and characteristics of failures in obstetric neuraxial analgesia and anesthesia: a
retrospective analysis of 19,259 deliveries. Int J Obstet Anesth 2004;13:227-33.

[3] Hermanides J, Hollmann M, Stevens M, Lirk P. Failed epidural: causes and management. Br J Anaesth 2012;109:144-54.

[4] Motamed C, Farhat F, Rémérand F, Stéphanazzi J, Laplanche A, Jayr C. An analysis of postoperative epidural analgesia
failure by computed tomography epidurography. Anesth Analg 2006;103:1026-32.

[5] Tielens LK, Bruhn J, Vogt M, van Geffen GJ, Scheffer GJ. The Episure Autodetect syringe, a loss-of-resistance technique
for locating the epidural space, used in pediatric patients. Paediatr Anaesth 2013; 23:747-50.

[6] Levin J, Wetzel R, Smuck M. The importance of image guidance during epidural injections: rates of incorrect needle
placement during non-image guided epidural injections. J Spine 2012;1:1-3.

[7] Eappen S, Blinn A, Segal S. Incidence of epidural catheter replacement in parturients: a retrospective chart review. Int J
Obstet Anesth 1998;7:220–5.

[8] Jize Feng, Jincai Zou, Jianhua Wong. The application value of LOR Indicator Syringe in epidural puncture. China Journal of
Pharmaceutical Economics, 2015;6:125-6.

[9] Junmei Hou, Wenping Jia, Feifei Zhao. The effectiveness comparation of LOR Indicator Syringe with positive pressure
syringe in epidural puncture. Hebei Medical Journal, 2016;08:1234-6.
 05
Order
Information
Indicator Kit (Mini 1)

I. LOR Indicator Syringe VI. Syringe

II. Epidural Needle VII. Air Filter
III. Spinal Needle
IV. Epidural Catheter
V. Medicine Filter
Epidural Indicator Kit
(Mini 1)
I. LOR Indicator V. Syringe
Syringe VI. Air Filter
II. Epidural Needle
III. Epidural Catheter
IV. Medicine Filter
Indicator Kit (Mini 2)

I. LOR Indicator V. Medicine Filter

Syringe VI. Syringe
II. Epidural Needle VII. Air Filter
III. Spinal Needle
IV. Epidural Catheter
Order Information

Single Package

NAME TYPE QUANTITY PER BOX QUANTITY PER CARTON

LOR INDICATOR SYRINGE 5ml 20pcs 400pcs

 Indicator Kit (Mini 1) Epidural Indicator Kit (Mini 1) Indicator Kit (Mini 2)
Pro. Cod SE11625C SE11625R SE11625T SE11827C CE11690C CE11690R CE11690T CE11890C

Lor Indicator Syringe √ √ √ √ √ √ √ √ √ √ √

Epidrual Needle 16G, 90mm √ √ √ √ √ √

Epidrual Needle 18G, 90mm √ √

Locking Epidrual Needle 16G, 80mm √ √ √

Spinal Needle 25G, 123mm √ √ √

Spinal Needle 27G, 123mm √

Locking Spinal Needle 25G, 130mm √ √

Epi. Catheter 19G √ √ √

Epi. Catheter- Reinforced 19G √ √ √ √

Epi. Catheter- Soft tip 19G √ √

Epi. Catheter 21G √ √

Medicine Filter 0.2μ √ √ √ √ √ √ √

Notice: 80mm Epidural needle is optional. Subcutaneous needle (22G, 16G) is optional. Quantity : 20pcs/box
FAQ
Question 1. What’s this? And how does it work?

It is LOR Indicator Syringe. It could be used for epidural

puncture. Now, I’ll show you how it works.
Step 1, Confirm the LOR Indicator Syringe is intact before
operation. If so, fill the syringe with about 5ml saline for use.
Step 2, begin to puncture. First we need to puncture the
epidural needle into ligamentum flavum, then remove the
stylet, and connect the prepared syringe with epidural needle
closely. After that push the plunger rod to the mark of 2ml to
make the balloon inflated, at the same time, you must keep
the needle against the dense tissue, or the balloon might get
deflated. Next, push the needle forward slowly, and avoid it
backward. When the balloon gets deflated immediately, it
means the needle enters into the epidural space successfully.
At this moment, advance the needle 1 to 2 mm to increase
the success rate. That’s how the LOR Indicator Syringe works.
FAQ
Question 2. If the balloon gets deflated, but you cannot go on
with next step operation, how to deal with it?

In this case, you can continue to advance the needle 1-2 mm. If
it is still difficult to insert the catheter, the needle might be
punctured into the soft tissue. In this case, you must pull the
needle out of the soft tissue until it comes to the subcutaneous
tissue. Adjust the needle’s direction, then conduct puncture
again. If you push the needle into the arachnoid membrane, the
balloon will also be deflated. In this case, you have to take
remedial measures.

In the process of puncturing, will the needle be punctured into

other tissues?
It might happen. Sometimes the puncture needle maybe
pushed into the soft tissue or arachnoid membrane, but so
does the glass syringe. The function of the product is mainly to
make puncture process visualized.
FAQ

Question 3. In the event that balloon deflates

slowly but operator feels entry into the epidural
space, why?
This might happen. When the epidural needle
punctures into the lateral epidural space, the space
is narrow and the balloon might be deflated slowly.
We can adjust the puncture direction and puncture
again.
FAQ
Question 4. When we use the LOR Indicator Syringe, what
shall we fill the syringe with, saline or air?
We recommend saline. The study shows saline is more
secure. If we use air, there is a risk of embolism.

Question 5. How is it packed and what’s the price of it?

It’s usually packed in an anesthesia kit with other medical
devices. However, it can be individually packaged either.
When it comes to the price, can I scan your badge? Our
sales team will contact you.

Question 6. Whether the syringe can be connected to any

other puncture needles? Do you have any other different
models?
Of course. Because the Luer taper conforms to the
international standard, it can be connected to any puncture
needles. For the moment, we only have one type LOR
Indicator Syringe.
FAQ

Question 7. Can the syringe be used for drug injection?

It cannot be.

Question 8. Could this product be used in Children or the aged?

As a matter of principle, after puncturing epidural needle into
ligamentum flava, connect it with LOR syringe. It’s ok if the
balloon can be inflated and maintain inflated state.
FAQ
Question 9. When is the needle connected with the
syringe?
When the epidural needle arrives at the dense tissue
(supraspinous ligament or interspinous ligament) or you
feel there is puncture resistance, the needle can be
connected with the syringe.

Question 10. Where is the best puncture position?

The lower, the better. There is no spinal cord under the
first lumbar vertibra and there is only nerve and capillary,
so we suggest the puncture position is under the third
lumbar vertibra.

Question 11. Could it be used in thoracic vertibra?

It could be used in thoracic vertibra puncture. The
application of LOR Indicator Syringe is same as the
Epidural Anesthesia.
FAQ

Question 12. Could we puncture with lateral

direction?
It’s ok.

Question 13. What about the pressure of balloon

after filled with saline?
Normally, when fill 3ml saline in the balloon, static
pressure is between 7-13KPA; fill 5ml saline in the
balloon, pressure is between 8-14KPA. Negative
pressure of epidural cavity is between 0.1-0.3KPA.
Con ta ct Us

Tuoren Medical Devices India Pvt. Ltd.

officein@etuoren.com
www.tuoren.in
+91 (0124) 400 3250
#511, 5th floor, Global Foyer, Golf Course Road, Sector-43 Contact Us
Gurugram 122002
Haryana, India