Analgesic efficacy using loss of resistance to air vs. saline in combined spinal epidural technique for labour analgesia.

Abstract:

:Identification of the epidural space is often performed using the loss of resistance technique to either air or saline. We sought to investigate if the medium used affected the quality of analgesia obtained by parturients who received labour epidurals. We conducted a retrospective audit of labour epidurals performed on nulliparous parturients in our institution from May 2003 to March 2005. All epidural catheters were inserted by senior obstetric anaesthetists using a combined spinal epidural technique. The following information was recorded: parturients' demographic data, loss of resistance technique used, type and amount of local anaesthetic solution administered, complications encountered during procedure, pre-block and post-block pain scores, incidence of breakthrough pain requiring supplemental medication and post-block side-effects. Data from 2848 patients were collected and analysed; 56% of patients made up the saline group and 44% the air group. Patients in both groups had similar demographic profiles and similar incidences of complications and post-block side-effects. However patients in the air group had a higher incidence of recurrent breakthrough pain P = 0.023). We also identified three other factors that were associated with an increased incidence of recurrent breakthrough pain; administration of pre-block oxytocin, sitting position of the parturient during the procedure and the use of intrathecal bupivacaine for induction of analgesia. Our findings suggest that a loss of resistance to air is associated with a higher incidence of recurrent breakthrough pain among parturients who received combined spinal epidural analgesia for labour than a loss of resistance to saline.

journal_name

Anaesth Intensive Care

authors

Leo S,Lim Y,Sia AT

doi

10.1177/0310057X0803600512

subject

Has Abstract

pub_date

2008-09-01 00:00:00

pages

701-6

issue

5

eissn

0310-057X

issn

1448-0271

pii

20080009

journal_volume

36

pub_type

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