Epidural space identification: a meta-analysis of complications after air versus liquid as the medium for loss of resistance

Anesthesia and Analgesia
Robert SchierBernhard Riedel

Abstract

The best method for identifying the epidural space for neuraxial blocks is controversial. We conducted this meta-analysis to test the hypothesis that loss of resistance with liquid reduces complications with epidural placement. The MEDLINE, EMBASE, and Cochrane databases were searched for prospective, randomized studies comparing air versus liquid as the medium for loss of resistance during epidural space identification in adults. Data were abstracted from 5 studies (4 obstetric and 1 nonobstetric) (n = 4422 patients) that met inclusion criteria and analyzed for the following 6 outcomes: difficult catheter insertion, paresthesia, intravascular catheter insertion, accidental dural puncture, postdural puncture headache, and partial block. The overall risk differences for adverse outcome between the different mediums were not statistically different for the obstetric population. A small, but statistically significant, risk difference for postdural puncture headache was observed when fluid was used during epidural placement for chronic pain management. Larger studies that overcome limitations of heterogeneity across studies and a relatively infrequent occurrence of complications are required to determine the optimal medium for loss...Continue Reading

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Citations

Jun 28, 2012·British Journal of Anaesthesia·J HermanidesP Lirk
Jan 1, 2010·Local and Regional Anesthesia·Marcos Silva, Stephen H Halpern
Aug 27, 2011·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Jean-Valery C E Coumans, Brian P Walcott
Feb 12, 2011·International Journal of Obstetric Anesthesia·J M Mhyre
Jan 3, 2013·Acta Anaesthesiologica Scandinavica·C L BradburyP M Jones
May 20, 2016·Journal of Anesthesia·Sung-Moon JeongSung-Hoon Kim
Jul 7, 2016·The Journal of Emergency Medicine·Aakash Kaushik ShahJames Kimo Takayesu
Oct 9, 2013·Korean journal of anesthesiology·Hyun Kyoung LimMi Hyeon Lee
Sep 14, 2017·Journal of Neurointerventional Surgery·Dimitrios K FilippiadisAlexis Kelekis
Nov 3, 2010·Acta Anaesthesiologica Scandinavica·B DarvishG Dahlgren
May 13, 2020·Korean Journal of Neurotrauma·Jinhwan Koo, Keun-Tae Cho
Oct 14, 2020·Neuro-Chirurgie·Hong Joon HanJeong Ju Ho
Nov 5, 2010·Current Opinion in Obstetrics & Gynecology

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