A Retrospective Effectiveness Study of Loss of Resistance to Air or Saline for Identification of the Epidural Space

Segal, Scott; Arendt, Katherine W.

doi:10.1213/ane.0b013e3181c84e4e

Cited by 38 publications

(11 citation statements)

References 17 publications

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“…We did not compare contrast with saline because Segal and Arendt have reported that the isotonic saline returning from a blocked needle might sometimes be mistaken for cerebrospinal fluid when the Tuohy needle is not yet in the epidural space, resulting in a failed block [ 3 ]. In the cervical region, anatomical studies have shown not only high rate of discontinuity, but also anatomic variability in the ligamentum flavum, which plays an inevitable role in the LOR technique.…”

Section: Discussionmentioning

confidence: 99%

Method to Reduce the False-Positive Rate of Loss of Resistance in the Cervical Epidural Region

Kim

Park

et al. 2016

Pain Research and Management

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Background. The cervical epidural space can be detected by the loss of resistance (LOR) technique which is commonly performed using air. However, this technique using air has been associated with a high false-positive LOR rate during cervical interlaminar epidural steroid injections (CIESIs). Objective. We investigated whether the detection of LOR with contrast medium might reduce the false-positive LOR rate on the first attempt. Methods. We obtained data retrospectively. A total of 79 patients were divided into two groups according to the LOR technique. Groups 1 and 2 patients underwent CIESI with the LOR technique using air or contrast medium. During the procedure, the injection technique (median or paramedian approach), final depth, LOR technique (air or contrast), total number of LOR attempts, and any side effects were recorded. Results. The mean values for the total number of LOR attempts were 1.38 ± 0.65 (Group 1) and 1.07 ± 0.25 (Group 2). The false-positive rate on the first attempt was 29.4% and 6.6% in Groups 1 and 2, respectively (P = 0.012). Conclusions. The use of contrast medium for LOR technique is associated with a lower rate of false-positivity compared with the use of air.

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Section: Discussionmentioning

confidence: 99%

Method to Reduce the False-Positive Rate of Loss of Resistance in the Cervical Epidural Region

Kim

Park

et al. 2016

Pain Research and Management

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“…With the LOR technique, a sudden change in resistance is detected by the easier injection of air, saline or both, and this is associated with the passage of the epidural needle tip from the ligamentum flavum into the epidural space [4-6]. …”

Section: Introductionmentioning

confidence: 99%

Comparison of loss of resistance technique between Epidrum® and conventional method for identifying the epidural space

Kim

et al. 2012

Korean J Anesthesiol

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BackgroundEpidrum® is a recently developed, air operated, loss of resistance (LOR) device for identifying the epidural space. We investigated the usefulness of Epidrum® by comparing it with the conventional LOR technique for identifying the epidural space.MethodsOne hundred eight American Society of Anesthesiologists (ASA) physical status I or II patients between the ages of 17 and 68 years old and who were scheduled for elective surgery under combined spinal-epidural anesthesia were enrolled in this study. The patients were randomized into two groups: one group received epidural anesthesia by the conventional LOR technique (C group) and the second group received epidural anesthesia using Epidrum® (ED group). While performing epidural anesthesia, the values of variables were recorded, including the number of failures, more than 2 attempts, the incidence of dural puncture, the time needed to locate the epidural space, the distance from the skin to the epidural space and ease of performance, and the satisfaction scores.ResultsThe ED group showed a lower failure rate, fewer cases of more than 2 attempts, a lesser time to identify the epidural space, and better ease and satisfaction scores of procedure than the C group, with statistical significance.ConclusionsUsing Epidrum® compared to the conventional LOR technique is an easy, rapid, and reliable method for identifying the epidural space.

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“…Though saline has not been proven superior to air,[676869] various anecdotal reports question safety of LOR to air. Injection of air into EDS has been associated with paresthesias, difficult catheter insertion, partial block, accidental dural puncture, and postdural puncture headache.…”

Section: Discussionmentioning

confidence: 99%

Localization of epidural space: A review of available technologies

Elsharkawy

Sonny

Chin

2017

J Anaesthesiol Clin Pharmacol

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Although epidural analgesia is widely used for pain relief, it is associated with a significant failure rate. Loss of resistance technique, tactile feedback from the needle, and surface landmarks are traditionally used to guide the epidural needle tip into the epidural space (EDS). The aim of this narrative review is to critically appraise new and emerging technologies for identification of EDS and their potential role in the future. The PubMed, Cochrane Central Register of Controlled Clinical Studies, and Web of Science databases were searched using predecided search strategies, yielding 1048 results. After careful review of abstracts and full texts, 42 articles were selected to be included. Newer techniques for localization of EDS can be broadly classified into techniques that (1) guide the needle to the EDS, (2) identify needle entry into the EDS, and (3) confirm catheter location in EDS. An ideal method should be easy to learn and perform, easily reproducible with high sensitivity and specificity, identifies inadvertent intrathecal and intravascular catheter placements with ease, feasible in perioperative setting and have a cost-benefit advantage. Though none of them in their current stages of development qualify as an ideal method, many show tremendous potential. Some techniques are useful in patients with difficult spinal anatomy and infants, and thus are complementary to traditional methods. In addition to improving the existing technology, future research should aim at proving the superiority of these techniques over traditional methods, specifically regarding successful EDS localization, better safety profile, and a favorable cost-benefit ratio.

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A Retrospective Effectiveness Study of Loss of Resistance to Air or Saline for Identification of the Epidural Space

Abstract: When used at the anesthesiologist's discretion, there is no significant difference in block success between air and saline for localization of the epidural space by LOR.

Cited by 38 publications

References 17 publications

Method to Reduce the False-Positive Rate of Loss of Resistance in the Cervical Epidural Region

Method to Reduce the False-Positive Rate of Loss of Resistance in the Cervical Epidural Region

Comparison of loss of resistance technique between Epidrum® and conventional method for identifying the epidural space

Localization of epidural space: A review of available technologies

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