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

Abstract

⊕⊕⊝⊝ low b ,d *The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio. GRADE Working Group grades of evidence. High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.

Confirmation of Loss-of-Resistance for Epidural Analgesia

“…Multiple articles have tackled the medium (air or saline). 17 Similarly, multiple improvements have been proposed to detect LOR (eg, pressurized syringe, microdrip method, continuous hydrostatic pressure system). [18][19][20] However, a potential drawback afflicting LOR may be its lack of specificity.…”

Localization of epidural space: A review of available technologies

“…Some of these techniques such as Epidrum and epidural balloon use air as the medium for LOR. Though saline has not been proven superior to air,[ 67 68 69 ] 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.…”

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

“…The establishment of epidural anesthesia depends on accurate identification of the epidural space. The loss of resistance (LOR) technique for identification of the epidural space seems to be the most commonly used method for the identification of the epidural space [1,2].…”

“…The methods used in identification of the epidural space are extremely important for effective anesthesia and to avoid potential complications, such as perforation of the dura mater, epidural hematomas (due to lesions of vessels from the needle and catheter), patchy blocks, low back pain and air venous embolisms [2,[29][30][31][32][33][34].…”