Loss of resistance to saline is better than air for obstetric epidurals

Russell, Robin

doi:10.1054/ijoa.2001.0879

Cited by 16 publications

(20 citation statements)

References 28 publications

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“…Addressing this issue, Russell (2) suggested that it is better to use a technique that reduces the incidence of complications rather than one that facilitates their diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…An advantage of using air is easy identification of a sticky syringe plunger, whereas a liquid usually provides better proprioception. Both techniques also have drawbacks (1,2): for example, epidural injection of air carries several risks (3-10), 1 and air bubbles within the epidural space can lead to incomplete (patchy) analgesia (11).…”

mentioning

confidence: 99%

“…There is thus no consensus as to whether air or a liquid should be used for identifying the epidural space when using a loss-of-resistance technique (1,2). It is also possible that sequential use of air and a liquid will provide the advantages of both methods.…”

mentioning

confidence: 99%

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Identification of the Epidural Space: Loss of Resistance with Air, Lidocaine, or the Combination of Air and Lidocaine

Evron¹,

Sessler²,

Sadan³

et al. 2004

Anesthesia & Analgesia

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The ideal technique for identifying the epidural space remains unclear. Five-hundred-forty-seven women in labor who requested epidural analgesia were randomly allocated to three groups according to the technique by which the epidural space was identified: 1) loss-of-resistance with air (air; n = 180), 2) loss-of-resistance with lidocaine (lidocaine; n = 185), and 3) loss-of-resistance with both air and lidocaine (air-plus-lidocaine; n = 182). We assessed ease of epidural catheter insertion, characteristics of the blockade, quality of analgesia, and complications. The inability to thread the epidural catheter occurred in 16% of the air, 4% of the lidocaine, and 3% of the air-plus-lidocaine patients (P < 0.001). More patients from the air group had unblocked segments (6.6% versus 3.2% and 2.2%, respectively; P < 0.02). The incidence of accidental dural puncture was greater in the air group (1.7% versus 0% in the other two groups; P < 0.02). Pain scores, time to onset of analgesia, upper sensory level, motor blockade, and the incidence of hypotension, transient neurological deficits, postpartum urinary retention, and postdural puncture headache were comparable. Identification of the epidural space with air was more difficult and caused more dural punctures than with lidocaine or air plus lidocaine. Additionally, sequential use of air and lidocaine had no advantage over lidocaine alone.

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“…Addressing this issue, Russell (2) suggested that it is better to use a technique that reduces the incidence of complications rather than one that facilitates their diagnosis.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Identification of the Epidural Space: Loss of Resistance with Air, Lidocaine, or the Combination of Air and Lidocaine

Evron¹,

Sessler²,

Sadan³

et al. 2004

Anesthesia & Analgesia

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“…Busoni reported that in over 10,000 epidurals in pediatric patients, there were no complications associated with the use of LORA. 5 Air may permit easier detection of a dural tap compared to saline 19 and the actual incidence of dural puncture in pediatric patients is greater with LORNS. 20 This is in direct contrast to adult patients in whom the continuous pressure of the saline technique pushes the dura away and so reduces the risk of dural puncture.…”

Section: Complications Of Epidural Anesthesia and Association With Tementioning

confidence: 99%

“…20 This is in direct contrast to adult patients in whom the continuous pressure of the saline technique pushes the dura away and so reduces the risk of dural puncture. 19,21 However LORA is associated with numerous complications that include venous air embolism (VAE), nerve root compression, sc emphysema, pneumocephalus, a greater incidence of incomplete analgesia and a higher incidence of paresthesia. 2 In the pediatric population, VAE is a major source of concern.…”

Section: Complications Of Epidural Anesthesia and Association With Tementioning

confidence: 99%

Loss of resistance to normal saline is preferred to identify the epidural space: a survey of Canadian pediatric anesthesiologists

Ames

Hayes

Petroz

et al. 2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Several methods have been described to locate the epidural space, but the loss-of-resistance (LOR) technique is the most commonly used. Expert opinion states that LOR to air is the best medium for neonates and infants. We conducted a Canadawide postal survey to determine the current state of practice for placement of epidural catheters in pediatric patients.M Me et th ho od ds s: : Two hundred and nine surveys were distributed to academic pediatric anesthesiologists across Canada. The survey was limited to six questions and was anonymous.

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Postpartum Headache

Macarthur¹

2009

Chestnut's Obstetric Anesthesia: Principles and Practice

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Loss of resistance to saline is better than air for obstetric epidurals

Cited by 16 publications

References 28 publications

Identification of the Epidural Space: Loss of Resistance with Air, Lidocaine, or the Combination of Air and Lidocaine

Identification of the Epidural Space: Loss of Resistance with Air, Lidocaine, or the Combination of Air and Lidocaine

Loss of resistance to normal saline is preferred to identify the epidural space: a survey of Canadian pediatric anesthesiologists

Postpartum Headache

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