Gasbag Anaesthesia Forums

Anesthesia Discussion => Regional Anesthesia => Topic started by: Russell Coupland on January 26, 2005, 02:13:20 AM

Poll
Question: How do you do your Epidurals
Option 1: Loss of resistance to air votes: 42
Option 2: Loss of resistance to saline votes: 18
Option 3: Hanging Drop votes: 7
Option 4: Other votes: 0
Title: How do you do your Epidurals?
Post by: Russell Coupland on January 26, 2005, 02:13:20 AM
Not that it means anything, but I am wondering how people do their epidurals?
Title: Re: How do you do your Epidurals?
Post by: Bucky on January 26, 2005, 03:26:51 AM

Generally, with the patient sitting.
Title: Re: How do you do your Epidurals?
Post by: Russell Coupland on January 26, 2005, 05:17:56 AM
Sorry, I mustn't have been clear. I meant referring to the poll at the top: Do you use LOR to air/saline or hanging drop. You can vote in the poll or add a comment.

I certainly do not mean this to be an argument of WHY or WHICH IS BEST, I'm just interested in how many people do what.
Title: Re: How do you do your Epidurals?
Post by: alroth on June 26, 2005, 08:07:57 PM
In my state in Brazil almost ALL anesthesiologists use AIR.
Title: Re: How do you do your Epidurals?
Post by: hillpeng on August 18, 2005, 03:48:59 PM
use air always in my hospital
Title: Re: How do you do your Epidurals?
Post by: Bie on September 09, 2005, 08:21:04 PM
lumbal : saline

thoracal: hanging drop

as far as i know, no one uses air in the hospital where i work.


Title: Re: How do you do your Epidurals?
Post by: Stefano_Soriano on November 08, 2005, 07:00:10 PM
I use saline (like the great part of anesthesist), but some collegue air

Stefano from South Italy (Calabria/Sicilia)
Title: Only preservative free bupivacaine for epidurals?
Post by: dr angela recio on August 17, 2006, 02:15:10 AM

I stopped using bupivacaine containing preservatives for epidurals and caudals, at least 14 years ago, and I`ve been using only  preservative free bupivacaine because of the risk of arachnoiditis.Just yesterday, though, I met someone that still uses the regular bupivacaine containing preservatives for epidurals everyday, and so do all his co workers.
What do you think about this?Is it acceptable?even though the risk of arachnoiditis exists?
have there been  any recent report of arachnoiditis following epidurals? I havenĀ“t found any in the internet.
Title: Re: How do you do your Epidurals?
Post by: amarnath on November 21, 2006, 04:34:58 PM
I've done nearly about 80 epidurals (thoracic & lumbar) in total, all using LOR with air syringe..
I'm a postgraduate in MMC, Chennai. We get lot of exposure in this technique....but need to know what you people do too..
Title: Re: How do you do your Epidurals?
Post by: amarnath on November 21, 2006, 04:37:49 PM
I've done nearly about 80 epidurals (thoracic & lumbar) in total, all using LOR with air syringe..
I'm a postgraduate in MMC, Chennai. We get lot of exposure in this technique....but need to know what you people do too..
Title: Re: How do you do your Epidurals?
Post by: barakuri on December 16, 2006, 06:52:41 PM
For simple Lumbar epidural I uses air syringe & keep women sitting, especially obese.
But lateral position appropriate as well.
Saline in syringe  [european school] & work good if any complication anticipated.
Also I uses saline to lubricate pathway for catheter, after proper localisation of needle in peridural space.
::)//
Title: Re: How do you do your Epidurals?
Post by: frontier on January 06, 2007, 07:59:14 AM
hi,
i am dr simant from ranchi,jharkhand,india.i am experienced in giving epidural both in lumbar & thoracic region.in my view sitting position is comfortable one.if patient can't sit then go for left lateral position.if you are going for lumbar epidural then go via median route,if you fail choose paramedian route.in case of thoracic epidural always go through paramedian route.its technically more easy.in the case of adult use air for loss of resistance.in case of child use saline for loss of resistance
Title: Re: Only preservative free bupivacaine for epidurals?
Post by: yogenbhatt1 on April 18, 2007, 12:26:14 PM
Since it is printed on the literature of the multidose vial that this should not be used for Epidural, it makes it even more difficult to use as some one may file a suit taht even the manufacturer also mentions that local anaesthetic with preservative should not be used for Epdural.
One teaching institution in Mumbai, India, now recommends to use Preservative free ampuoles available for spinal and dilute it to your need and use in Epidural space.
I have also done that and now quite happy to do it on regular bases.
Title: Re: How do you do your Epidurals?
Post by: amarkatira on April 21, 2007, 03:00:40 PM
most of the time we use sitting position,and loss of resistance to air
Title: Re: Only preservative free bupivacaine for epidurals?
Post by: yogenbhatt1 on May 24, 2007, 02:16:33 AM
In an elderly  or severly malnourished patient, try using a running saline drip for locating the epidural space. Just connect a saline drip after entering the skin. keep advancing. In htese patients generally no FEELs are felt. The drip does not go till you enter the space and here the drip starts running. Even the onlookers are amazed.
Title: Re: Only preservative free bupivacaine for epidurals?
Post by: dramitshah on July 10, 2007, 12:03:08 PM
Quote from: yogenbhatt1 on May 24, 2007, 02:16:33 AM
In an elderly  or severly malnourished patient, try using a running saline drip for locating the epidural space. Just connect a saline drip after entering the skin. keep advancing. In htese patients generally no FEELs are felt. The drip does not go till you enter the space and here the drip starts running. Even the onlookers are amazed.

dear  dr yogenbhai,
is your technique possible in all patients or only very old malnourished patient and if only for this group of patients than can you explain possible mechanisam for this ?
Title: Re: How do you do your Epidurals?
Post by: amarkatira on July 14, 2007, 02:59:58 PM
we are doing regularly in sitting position with loss of resistance to air.
Title: Re: Only preservative free bupivacaine for epidurals?
Post by: yogenbhatt1 on August 22, 2007, 10:14:36 AM
Dear Dr. Amit Shah,
   When we use NS in a LOR syringe, no matter how much you try, the pressure exerted on the piston can never be the same. Even after a  feel developed over 25 years of practice, I have entered dura. The tissue resistance in poorly nourished or elderly or cachectic patients is so low, that at every level you will be able to push the piston of LOR syringe, even when filled with NS.
    When you use a saline drip set with a NS bottle, the height where it is hanged from remains same, and the gravitational force will remain same throughout the whole procedure. This is how it works by exerting a steady pressure due to gravity. The moment you are in epidural space the NS drip starts running at a steady and good speed.
Note: I have manaed to  puncture dura once even by this method. I was sure that I am in space , but there was no flow from drip, so I pushed further and there was dura puncture. But the raitio of success is very good.
Try it a couple of times with a 100 ml NS bottle and see.
Title: Re: How do you do your Epidurals?
Post by: yogenbhatt1 on August 22, 2007, 10:24:10 AM
Dear Amarkatira '
Hi , read your note about using air in all Epidurals. I attended a CME lecture some time back, and was shocked to hear a statement made by the speaker. She mentioned about a study conducted with air, and it was proved that when they placed Transe Esophagial Probe of ultra sound, they realised that almost 90 % patients had air embolism. In a small child even 5 ml of Air can be very dangerous, if this study is anywhere near right.
The speaker was Dr. Laxmi Vaz, a very famous Paediatric Anaesthesiologist, now only in pain management in Mumbai. I really  do not know the refference of the article, but if it is true, I think, you start using NS. You will get used to it in the first case only.
Title: Re: How do you do your Epidurals?
Post by: jafo1964 on August 25, 2007, 10:38:09 AM
Just a case report
We tried this technique of saline infusion - gravitational flow to identify space

Once space is identified the NS infusion is removed and catheter threaded. During this time the saline flows back through the catheter and scarily could also be CSF tap due to the advancing catheter
So you need a definitve methid to tell the difference between the two

One of our resident assumed the back flow to be NS, and  as usual proceeded to dose the patient. He ended up with a total spinal with patient in cardiovascular collapse and apnoea

I fully agree with Dr. Vaz's statistics
But  LOR air syringe still survives as a technique.
Also air deposited into epidural space can form pockets around nerve roots and prevent LA from coming in contact with it thus producing patchy blocks.

I use Lor air syringe and what technique you train in and gain experience with you are comfortable performing
Hope all the youngsters switch to LOR saline