title: Comparison of the techniques for the identification of the epidural space using the loss-of-resistance technique or an automated syringe - results of a randomized double-blind study.
abstract: BACKGROUND
  The conventional, loss of resistance technique for identification of the epidural space is highly dependent on the anaesthetist's personal experience and is susceptible to technical errors. Therefore, an alternative, automated technique was devised to overcome the drawbacks of the traditional method. The aim of the study was to compare the efficacy of epidural space identification and the complication rate between the two groups - the automatic syringe and conventional loss of resistance methods.
  
  
  METHODS
  47 patients scheduled for orthopaedic and gynaecology procedures under epidural anaesthesia were enrolled into the study. The number of attempts, ease of epidural space identification, complication rate and the patients' acceptance regarding the two techniques were evaluated.
  
  
  RESULTS
  The majority of blocks were performed by trainee anaesthetists (91.5%). No statistical difference was found between the number of needle insertion attempts (1 vs. 2), the efficacy of epidural anaesthesia or the number of complications between the groups. The ease of epidural space identification, as assessed by an anaesthetist, was significantly better (P = 0.011) in the automated group (87.5% vs. 52.4%). A similar number of patients (92% vs. 94%) in both groups stated they would accept epidural anaesthesia in the future.
  
  
  CONCLUSIONS
  The automated and loss of resistance methods of epidural space identification were proved to be equivalent in terms of efficacy and safety. Since the use of the automated technique may facilitate epidural space identification, it may be regarded as useful technique for anaesthetists inexperienced in epidural anaesthesia, or for trainees.
authors: 1st Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Poland. dunieclarysa@gmail.com.
authors: Larysa
authors: L
authors: Duniec
authors: Piotr
authors: P
authors: Nowakowski
authors: Jakub
authors: J
authors: Sieczko
authors: Marcin
authors: M
authors: Chlebus
authors: Tomasz
authors: T
authors: Łazowski
mesh_terms: D000328:Adult; D000368:Aged; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods*; D000072077:Anesthetists; D001331:Automation; D004311:Double-Blind Method; D004824:Epidural Space / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D000070659:Patient Comfort; D013594:Syringes
keywords: automatic identification; epidural anaesthesia; epidural space; identification; loss-ofresistance technique