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The choice of using air or saline in epidural syringes during laboring parturients. Results are mixed. However, they seem
the loss-of-resistance technique, for identifying the epidural to indicate that the use of saline for the loss-of-resistance
space, has been based largely on personal preference of the may result in more rapid and satisfactory quality of pain relief
anesthesia provider. A survey of practice in the United King- in laboring parturients.
dom, thought to be similar to practice in the United States, Current anesthesia literature suggests using saline with an
revealed that the majority of anesthesia providers use air. air bubble in the loss-of-resistance syringe. Many anesthesia
Case reports have appeared in the literature suggesting training programs continue to teach the use of air, saline, and
that air may be harmful to patients or, at the very least, saline with an air bubble. Further studies may help to deter-
impede the onset and quality of epidural analgesia. Two stud- mine whether there is a scientific or safety basis for using air
ies have evaluated air vs saline to determine whether one vs saline.
may lead to more rapid or better quality epidural analgesia in Key words: Air, analgesia, epidural, loss of resistance, saline.
* AANA Journal Course No. 23: The American Association of Nurse Anesthetists is accredited as a provider of continuing education in nursing by
the American Nurses Credentialing Center Commission on Accreditation. The AANA Journal course will consist of 6 successive articles, each with
objectives for the reader and sources for additional reading. At the conclusion of the 6-part series, a final examination will be printed in the AANA
Journal. Successful completion will yield the participant 6 CE credits (6 contact hours), code number: 25468, expiration date: July 31, 2004.
reports, the case reports seem to share 3 common marily on case reports. Finally, the common theory
themes. The first is that the side effects reported seem behind the possibility of air as the cause of inadequate
to be related to the volume of air or saline injected. A or slow analgesia is that air actually impedes the
second is that air remains in the peridural area for not absorption of the local anesthesia molecules.1
just hours or a day or two as once thought; it often A literature review on this topic would be incom-
remains for many days.7,11,13 This was confirmed by plete without a review of what the leading anesthesia
radiography. In light of this fact, relatively few studies textbooks have taught during the past 10 to 15 years.
have been conducted to effectively determine whether A chronology with quotes from their description of
there really is an increased risk with air or whether the LOR technique is given in the Table.19-35
there exists a clinically significant scientific reason to Clearly, further studies may help determine
advocate the use of one substance over the other. Even whether the use of air or saline leads to a more rapid
though there are just a few studies reported in the lit- onset and better quality of analgesia and a better
erature on this subject, it seems that multiple authors safety profile. Before making a premature conclusion
advocate the use of saline rather than air, based pri- that air or saline is the cause of these complications, it