Neurological Damage Resulting from Extracorporeal Shock Wave Lithotripsy When Air is Used to Locate the Epidural Space

Paraplegia following cervical epidural catheterization using loss of resistance technique with air: a case report

“…All reported complications of paresis or paraplegia caused by epidural air are related with lumbar epidural block or catheterization using a large volume of air for LOR [ 1 2 3 ]. Among the reported adverse symptoms resulting from an epidural block using air for LOR, only 2 ml of air for LOR would produce inadequate analgesia or bilateral limited leg mobility with pain at the lumbar epidural injection site [ 12 13 ]. Although there is still no consensus on whether air or saline would be superior for LOR, it is generally accepted that a small amount of air should be used for the procedure.…”

Airor nitrous oxide for loss-of-resistance epidural technique?

“…The phenomenon of confined epidural air pockets becoming further enlarged when N 2 O is simultaneously used as a part of general anesthesia and its associated complications is well reported. [3][4][5]10 Theoretically, the use of N 2 O for LOR should alleviate this problem. On the contrary, the size of N 2 O pockets should become further reduced due to their greater solubility compared with air.…”

“…OSS of resistance (LOR) to injection of air is a common, simple and established technique for identifying the epidural space, but it may be associated with complications such as missed segments, neurological damage and venous air embolism. [1][2][3][4][5] Complications may increase with the use of large volumes of air in difficult cases or when confirmation of the correct placement of the epidural needle is required. In a survey of practicing anesthesiologists in India, it was found that the use of 6 to 10 ml air for LOR was common practice.…”

Commonly-used versus less commonly-used methods in the loss of resistance technique for identification of the epidural space: A systematic review and meta-analysis of randomized controlled trials

“…However, both methods also present disadvantages [3,5,6]. Epidural injection of air implies some hazards [7][8][9][10][11], and air bubbles in the epidural space can result in only partial analgesia [12]. Also, complications may increase with the use of large volumes of air when validation of the correct placement of the epidural needle is needed [13,14].…”