Identification of the epidural space-loss of resistance to saline: An inexpensive modification

Dhansura, Tasneem; Shaikh, Tarana; Maadoo, Mohtassib; Chittalwala, Fatema

doi:10.4103/0019-5049.167483

Cited by 8 publications

(6 citation statements)

References 8 publications

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“…Loss of resistance to saline is an accepted method of identification of the epidural space even in parturients and the volumes that can enter the epidural space is variable. [ 10 ] The practice of avoiding test dose and administering the first dose of labor analgesia is practised in obstetrics. [ 11 ] Saline pre-distension of epidural space with 2 ml versus 10 ml prior to test dose has reported wider dermatomal block in parturients.…”

Section: Discussionmentioning

confidence: 99%

“…The large volume of saline that was used was based on the saline volumes with LOR to saline technique [ 9 ] or the pre-distension of epidural space in the obstetric population. [ 10 11 ] Perhaps, pre-distension or use of smaller volumes of saline of 3–4 ml may provide early sensory loss without undesirable haemodynamic side effects. This would be beneficial in elderly and frail population where haemodynamic changes are exaggerated.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of segmental epidural blockade following standard test dose versus test dose with addition of saline in abdominal surgeries

et al. 2020

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Background and Aims: Epidural analgesia is widely used for pain relief but confirmation of accurate epidural placement is poorly understood. We proposed that sensory blockade to cold sensation would predict the accurate placement of epidural. The primary outcome was the assessment of sensory blockade at 5 and 10 min with a standard epidural test dose versus test dose with additional saline. We looked at haemodynamic changes following administration as secondary outcomes. Methods: Following Ethics Committee approval, 161 patients presenting for elective abdominal surgery needing epidural analgesia with general anaesthesia were randomly allocated into Group 1 receiving standard test dose (3 ml of 2% lignocaine with 1:2,00,000 adrenaline) or Group 2 (standard test dose with 6 ml of saline) epidurally. The blockade to cold sensation was assessed at 5 and 10 min. The heart rate (HR), systolic blood pressure (SBP), and mean arterial pressure (MAP) were recorded at baseline, 1, 5, and 10 min following epidural dosing. Statistical analysis was performed with Chi-square test for categorical and Student's t -test for continuous variables. Results: The sensory blockade at 5 min was 69.5% versus 82.3% ( P = 0.059), and at 10 min 85.4% versus 97.5% ( P = 0.01) in Groups 1 and 2, respectively. The MAP at 5 min ( P = 0.032) and the HR and MAP at 10 min ( P = 0.015, 0.04) were significantly lower in Group 2. Conclusion: An epidural test dose of 3 ml followed by additional 6 ml saline accurately predicted sensory blockade to cold at 10 min in comparison to the standard dose of 3 ml but was associated with a decrease in the HR and MAP.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of segmental epidural blockade following standard test dose versus test dose with addition of saline in abdominal surgeries

et al. 2020

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“…Few other studies by Saberski L R et al, (11) Dhansura T et al (12) (2015) have proved simple loss of resistance technique is safe and effective in resource-poor settings.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Techniques- Identification of Epidural Space Using the Loss of Resistance Syringe and an Automated Syringe

Dilish¹,

Murugesan²,

Jayasree³

2017

jemds

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BACKGROUNDWith the concerns regarding the higher amount of time taken for epidural needle insertion and higher failure rate and complication rate with conventional loss of resistance techniques, various new innovative techniques have been introduced into anaesthetic practice. But the studies comparing these advanced methods on Indian population with conventional methods are scarce.The aim of this study is to compare the efficacy of identification of epidural space using conventional LOR syringe versus automated Epimatic syringe.

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“…However, due to financial constraints, it may be useful to search alternative and cheaper techniques of expensive anaesthesiologic procedures, particularly of epidural anaesthesia. [6] So, we introduce LORT method with possibility of having both hands on needle. For this, one will need epidural needle, two regular 10cc syringes and a 3-way stopcock.…”

mentioning

confidence: 99%

“…Besides, these volumes never lead to barrel jumping out of the syringe. This pressure is higher than the pressures produced by Epimatic® and Episure Autodetect® syringes[6] but according to literature this pressure can be safely used for epidural space identification with LORT. [7]…”

mentioning

confidence: 99%

Alternate method of loss of resistance test using 3-way stopcock and two syringes

et al. 2019

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Identification of the epidural space-loss of resistance to saline: An inexpensive modification

Cited by 8 publications

References 8 publications

Evaluation of segmental epidural blockade following standard test dose versus test dose with addition of saline in abdominal surgeries

Evaluation of segmental epidural blockade following standard test dose versus test dose with addition of saline in abdominal surgeries

Comparison of Techniques- Identification of Epidural Space Using the Loss of Resistance Syringe and an Automated Syringe

Alternate method of loss of resistance test using 3-way stopcock and two syringes

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