Air versus saline in the loss of resistance technique for the identification of the epidural space

Management practices for postdural puncture headache in obstetrics: a prospective, international, cohort study

“…17,18 The use of air or saline for detection of LoR remains controversial, but a recent Cochrane review found no difference in several endpoints, including PDPH, using either technique. 19 Accidental injection of air intrathecally results in an almost immediate onset of PDPH (<1 h), with a shorter duration compared with PDPH after using saline for LoR. 20 This rapid onset and faster recovery of headache may explain the reduced application of an EBP for management of PDPH after the use of air for LoR.…”

Combined Spinal-Epidural Anesthesia for Subtotal Colectomy in a Patient With Hamman Syndrome and Epidural Pneumatosis: A Case Report

“…No significant difference in the incidence of complications or analgesic effect has been demonstrated when using LOR with air versus saline. 13 Although we could not identify previous reports of neuraxial anesthesia in the presence of epidural pneumatosis, we postulated that epidural anesthesia would be effective because of the long clinical history of using LOR with air during epidural anesthesia.…”

Pneumomediastinum: A Rare Complication of Epidural Analgesia

“…As the needle negotiates its way through the ligamentum flavum into the epidural space, a distinct loss of resistance is encountered, and air or saline enters the epidural space confirming the correct position of the needle tip. LOR techniques with air as well as saline are comparable in terms of success rate and complications [ 2 ]. The LOR technique with air is still preferred by some anesthesiologists as it provides a better feel of compressibility as well as differentiation from cerebrospinal fluid in case of inadvertent dural puncture [ 3 ].…”