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• Loss of resistance to air

  42 (62.7%)

  Loss of resistance to saline

  18 (26.9%)

  Hanging Drop

  7 (10.4%)

  Other

  0 (0%)

Total Members Voted: 67

[Russell Coupland]

Not that it means anything, but I am wondering how people do their epidurals?

[Bucky]

Generally, with the patient sitting.

[Russell Coupland]

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.

[alroth]

In my state in Brazil almost ALL anesthesiologists use AIR.

[hillpeng]

use air always in my hospital

[Bie]

lumbal : saline

thoracal: hanging drop

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

[Stefano_Soriano]

I use saline (like the great part of anesthesist), but some collegue air

Stefano from South Italy (Calabria/Sicilia)

[dr angela recio]

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 haven´t found any in the internet.

[amarnath]

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..

[amarnath]

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..

[barakuri]

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.
 

[frontier]

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

[yogenbhatt1]

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.

[amarkatira]

most of the time we use sitting position,and loss of resistance to air

[yogenbhatt1]

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.