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Identification of Epidural Space Using Modified Drip Method and Loss of Resistance Syringe Technique

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Background: Epidural anesthesia has become an integral part of today’s anesthesia practice. There are various techniques to identify epidural space like, LOR (Loss of resistance) with saline or air, Hanging drop method, MDM (Modified running drip method) and balloon method. Aims and objectives: To compare time taken to locate epidural space and ease of epidural catheter insertion among LOR with saline and MDM. Methods: 60 healthy patients of either sex, ASA-I or II physical status, between aged 20 to 60 years, scheduled to undergo lower abdominal and lower limb surgeries were randomly assigned to one of the two groups. (30 each). In LOR group (Group A): the lumbar epidural space was identified by using the LOR technique with saline. MDM Group (Group B): the lumbar epidural space was identified by using the modified drip method (MDM). Time taken to locate epidural space (T1), time taken to thread epidural catheter (T2) and quality of block were recorded. Results: The mean time taken to localize the epidural space was less in MDM than LOR but the difference was found statistically insignificant. (p=0.59).) Mean time taken to thread epidural catheter T2 was more in LOR than MDM which is also statistically not significant (p=0.76). Accidental dural puncture was seen in one patient in MDM and four patients in LOR. 3 cases of incomplete block were found in LOR while 1 case in MDM group which is not statistically significant. Conclusion: We believe that MDM is one of the most accurate visual method of identifying epidural space and useful for teaching the epidural blockade to students and residents.

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Background: Epidural anesthesia has become an integral part of today’s anesthesia practice. There are various techniques to identify epidural space like, LOR (Loss of resistance) with saline or air, Hanging drop method, MDM (Modified running drip method) and balloon method. Aims and objectives: To compare time taken to locate epidural space and ease of epidural catheter insertion among LOR with saline and MDM. Methods: 60 healthy patients of either sex, ASA-I or II physical status, between aged 20 to 60 years, scheduled to undergo lower abdominal and lower limb surgeries were randomly assigned to one of the two groups. (30 each). In LOR group (Group A): the lumbar epidural space was identified by using the LOR technique with saline. MDM Group (Group B): the lumbar epidural space was identified by using the modified drip method (MDM). Time taken to locate epidural space (T1), time taken to thread epidural catheter (T2) and quality of block were recorded. Results: The mean time taken to localize the epidural space was less in MDM than LOR but the difference was found statistically insignificant. (p=0.59).) Mean time taken to thread epidural catheter T2 was more in LOR than MDM which is also statistically not significant (p=0.76). Accidental dural puncture was seen in one patient in MDM and four patients in LOR. 3 cases of incomplete block were found in LOR while 1 case in MDM group which is not statistically significant. Conclusion: We believe that MDM is one of the most accurate visual method of identifying epidural space and useful for teaching the epidural blockade to students and residents.

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This page is a summary of: Identification of Epidural Space Using Modified Drip Method and Loss of Resistance Syringe Technique: A Comparative Study, Indian Journal of Anaesthesia and Analgesia, January 2019, Red Flower Publication Private, Ltd.,
DOI: 10.21088/ijaa.2349.8471.6219.33.
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