Regional anesthesia
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Regional anesthesia · Jan 1997
ReviewIdentification of the epidural space: is loss of resistance to air a safe technique? A review of the complications related to the use of air.
The major determinant of successful epidural anesthesia is the localization of the epidural space. The manual loss of resistance technique is widely used by anesthesiologists in identifying the epidural space. Should air or saline be used in detecting the point of loss of resistance? No consensus exists as to which technique is superior, and individual providers currently use the technique with which they are most comfortable. The incidence of adverse effects associated with the use of epidural air is unknown and may be underreported as the effects may be unrecognized or considered trivial. The authors comprehensively review the complications of epidural air from published reports. ⋯ The potential complications associated with the use of air for identifying the epidural space with the loss of resistance technique may outweigh the benefits. The use of saline to identify the epidural space may help to reduce the incidence of these complications.
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Myofascial pain syndrome (MPS) is a common condition often resulting in referral to a pain clinic. The epidemiology, pathogenesis, and various diagnostic tools are reviewed, and a variety of treatment methods are discussed. ⋯ The definitive pathogenesis of MPS is currently unknown, and no single diagnostic method is consistently positive. While trigger-point injection is the most widely employed method of treatment, other modes of therapy have also proved to be effective.