glass LOR syringe

[MaximusD]

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25g. Quinke. It slices, it dices it steers. Have not needed a 22g outside of scar fro prior surgery.

I no longer trust or believe in LOR as useful for anything but SCS.

Wow. Can’t imagine ever giving up on LOR technique.

 

[epidural man]

25g. Quinke. It slices, it dices it steers. Have not needed a 22g outside of scar fro prior surgery.

I no longer trust or believe in LOR as useful for anything but SCS.

Can you expand on this idea?

I get that you have found another technique that works really well for you.

But why don't you believe in LOR? Or why not trust it?

 

[lobelsteve]

Literature. See refs in algos old posts.

 

[244913]

Weaning anesthesiologists off glass LOR syringes is like weaning babies from mom's nipple. I say this as a Gas doc..

 

[lobelsteve]

Never used glass, liked cheap plastic. Now, what's the point? I have to watch my needle tip enter the canal under live fluoro for my own edification.

 

[nvrsumr]

I just use the guide wire for SCS to determine epidural no LOR

 

[drrosenrosen]

Is there any "feel" to your approach, Steve, or do you just go with puffs of contrast every 1mm? Touch lower lamina first and then walk off?

 

[lobelsteve]

Is there any "feel" to your approach, Steve, or do you just go with puffs of contrast every 1mm? Touch lower lamina first and then walk off?

Start on skin over lamina, touch lamina, turn bent tip superior, advance paramedian 1-2mm and go lateral or CLO and 1 puff contrast every 1-2mm until dye pattern is in the space.

 

[NJPAIN]

Learned on air in glass as resident. Switched to saline in plastic LOR syringe as fellow. Despite training and experience as an anesthesiologist, I find it difficult to depend on “feel” when there is imaging. I tend to roll my eyes when I hear docs brag about how little fluoro time they use. Sure it’s great to minimize exposure but I believe you are likely to sacrifice safety. I’m even finding it difficult to have much faith in LOR any longer.


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[drrosenrosen]

Learned on air in glass as resident. Switched to saline in plastic LOR syringe as fellow. Despite training and experience as an anesthesiologist, I find it difficult to depend on “feel” when there is imaging. I tend to roll my eyes when I hear docs brag about how little fluoro time they use. Sure it’s great to minimize exposure but I believe you are likely to sacrifice safety. I’m even finding it difficult to have much faith in LOR any longer.

I feel like it depends. There are some times, especially in the neck, when you really never have a good resistance feel at all, and then I'm likely to fluoro more. Based on posts here, I have actually gone to squirting contrast every mm or so in the neck so I get a good "pre/post" contrast image, in the ligament and then through the ligament. But a lot of times for lumbar, if I feel that good classic resistance, I'll use fluoro just for confirmation.

I'm still trying to build up the courage to try Steve's way. Now that I think about it, though, I think the senior partner at my first job did epidurals that way.

 

[epidural man]

Weaning anesthesiologists off glass LOR syringes is like weaning babies from mom's nipple. I say this as a Gas doc..

Probably true. I’ll never abandon LOR. You guys are going to smaller needles, I’ll likely go bigger. I use 18. If someone hands me 14, i’d use that. Feel means a lot to me.

Those tiny needle would scare me to no end. (Plus I can’t seem to get those stories of people with small pencil point needles who injected the cord out of my head.).

It also doesn’t help that I have seen hundreds of TAP blocks with both touhys and cutting needles. Those sharp needles pierce any tissue so easily. One has to often struggle to get that touhy to enter the fascia plane. I’d take that blunt touhy in the neck any day.

But I may lack the skill to use a sharp needle in the neck. I don’t mind admitting that.