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LETTER TO THE EDITOR

Predistention of the Epidural Space with Saline Before Catheter Insertion

Department of Anesthesiology; American University of Beirut; Beirut, Lebanon; ss01{at}aub.edu.lb

To the Editor:

Evron et al. showed that, in laboring women, predistention of the epidural space with 5 vs 2 mL saline before epidural catheter insertion decreased the incidence of accidental venous cannulation and the number of unblocked segments (16% vs 2%, respectively). The quality of analgesia was similar between the two groups.1 Similarly, we previously reported in parturients during the first stage of labor that injection of 10 vs 2 mL saline after identification of the epidural space was associated with a higher total number of dermatomes blocked for cold and pinprick sensation. Also, there was a trend towards a lower incidence of blood vessel trauma in the 10 mL group as compared with the 2 mL group (3.8% vs 1.9%).2 One additional issue regarding this subject is that a large volume of normal saline in the epidural space may dilute local anesthetics, thereby reducing the potency of analgesia.3,4 However, we found adequate analgesia in both groups, which may be attributed to the use of a test dose lidocaine 2% to be followed by bupivacaine 0.1% and fentanyl 2 µg/kg.2

REFERENCES

1. Evron S, Gladkov V, Sessler DI, Khazin V, Sadan O, Boaz M, Ezri T. Predistention of the epidural space before catheter insertion reduces the incidence of intravascular epidural catheter insertion. Anesth Analg 2007;105:460–4[Abstract/Free Full Text]
2. Siddik-Sayyid SM, Taha SK, Aouad MT, Daaboul DG, Deeb PG, El Khatib MF, Baraka AS. The effect of injection of two vs 10 mL saline on the subsequent spread and quality of epidural analgesia in parturients. J Clin Anesth 2006;18:575–9[Web of Science][Medline]
3. Okutomi T, Hoka S. Epidural saline solution prior to local anesthetic produces differential nerve block. Can J Anaesth 1998;45:1091–3[Web of Science][Medline]
4. Iwama H. Injection volume of saline with loss of resistance method may affect the spread of epidural anesthesia. Anesthesiology 1997;86:507–8[Web of Science][Medline]

This article has been cited by other articles:

				S. Evron and T. Ezri Predistention of the Epidural Space with Saline Before Catheter Insertion Anesth. Analg., February 1, 2008; 106(2): 672 - 673. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Siddik-Sayyid, S. M. Articles by Baraka, A. S. Search for Related Content PubMed PubMed Citation Articles by Siddik-Sayyid, S. M. Articles by Baraka, A. S.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999