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Modification of Loss of
Resistance Syringe forEasier Identification ofEpidural Space
Dr. Maulik R. Mehta
D.A., DNB Anaesthesia student
Dr. Mukesh Vakil
M.D. consultant and HOD
Dr. Suresh Barot
M.D. consultant
Dr. Himanshu Shah
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Epidural anaesthesia
IntroductionAcceptance across the globeSupported by many studies in Anaesthesiology
and Pain Medicine, establishing its effectiveness,
Now developments are in direction of improving
the technique for,
better precision,
easier technique,
fewer side effects.
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Detection of the
epidural spaceLoss Of Resistance Technique
(LORT)
Dogliotti's principle1:
In epidural anaesthesia, the
change of pressure from the
1.British Journal of Anaesthesia 22 (3): 150155.
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Difficulties with LORT
Even though LORT is widely used since decades
some problems are encountered with technique
like
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Difficulties with LORT
Subjective
feel
To appreciateL.O.R. when
pressure appliedon the plunger byoperator's thumb.
Anesth 2004;100, A72 ,BJA 44 (1): 122.
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Difficulties with LORT
Need of specialized syringe for LOR extremely low friction coefficient should move very smoothly
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Saline Air
Difficulties with LORT
Debate regarding which medium touse2
2, AANA J. 2003 Dec;71(6):449-53
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compressibility ofair
Better Subjectivefeel
Safer 3
No injection of airin a blood vessel,
No
pneumocephalus, No patchy andinadequateanalgesia
Saline Air
Difficulties with LORT
3, Anesth. 1997 Jan-Feb;22(1):3-15
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Difficulties with LORT
Lack of precision with one hand
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To overcome such
disadvantages, we modifiedthe LOR syringe so that the
new method retains all theadvantages of the loss of
resistance technique whilst inaddition it nullifies itsdisadvantages.
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Conversion of a regular LOR
syringe to self compressingspace detectorEquipments:
1. An elastic band which can just be acut end of a surgical glove as shownin the picture, and
2. A regular LOR syringe.
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Modification
As shown below make loop of band around LORsyringe.
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Modification
Stretch the loose end of the loop and wrap itover the plunger.
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Modification
The Modified LOR syringe is ready to locateepidural space.
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Identification TechniqueClick to edit Master text styles
Second level Third level
Fourth level Fifth level
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Advantages
Modification eliminates the need to
apply pressure on the plunger
use of both hands while advancing
slowly.
Entering the epidural space,
Plungers automatically compression
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Advantages continued.
Use of both hands provides,
Better precision,
Great control, Solid stability and Higher confidence.
Making the technique more,
Reliable, Quicker and Safer.
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Advantages continued.
Constant force on the plunger,
automatically compresses when the epidural
needle enters the epidural space,
Eliminates the subjective "feel"
required with standard LOR
syringes.
Reduced chances of creating false
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Advantages continued.
Air Vs Saline: no subjective feel is required
technically saline is as good as air. By avoiding air we can avoid all
complications related to it like, patchyblock, risk of air embolism, etc
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Advantages continued.
Scope for reducing the Cost:
Instead of LOR syringe, regular syringewith elastic band,
clinical studies required.
Till date no study done.
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Pilot Study
10 cases in each group:1. Group R - Regular LOR syringe
2. Group M - Modified LOR syringe
Data analyzed:
. Ease of technique (scale of 1 to 10),
1 = extremely difficult to 10 =extremely easy
. Time required for identification of space,
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Pilot Study
10 cases in each group:1. Group R - Regular LOR syringe
2. Group M - Modified LOR syringe
Data analyzed:
. Ease of technique (scale of 1 to 10),
1 = extremely difficult to 10 =extremely easy
. Time required for identification of space,
Intravascular catheter, Inadvertent dural puncture,
Failed block
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Results
Group R Group M
Ease of technique
(scale of 1 to 10)Mean S.D. 5.4 2.4 8.1 0.8
Mean Time required foridentification of space
(Sec.) S.D. 56 35
27 9.7
Complication(s)encountered 1 0
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Conclusion
By using material readily available inOperation Theater we can modify the LORto a self compressing epidural locator
syringe which provides a reliable, quickerand safer technique for identification ofthe epidural space.
Larger study required
In addition to being useful in difficultepidurals, the technique would also be an
excellent teaching aid, especially for
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Newer developments in field ofepidural anaesthesia are in direction of
developing similar syringes that maycome to market soon
But why to wait, if can modify syringe
with materials readily available in OT
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Newer developments in field ofepidural anaesthesia are in direction of
developing similar syringes that maycome to market soon
But why to wait, if can modify syringe
with materials readily available in OT