ABSTRACT
This study examined whether air or saline, used for the loss-of-resistance (LOR) technique, resulted in a difference in pain relief or adverse events for laboring parturients. Previous studies had mixed findings regarding the onset of analgesia and subsequent pain relief. Research questions were as follows: Is there difference in analgesic onset for patients receiving air vs saline during the LOR technique? Do women receiving the air method for LOR experience any difference in the quality of pain relief from that of women receiving saline? Is there any difference in the incidence of analgesic distribution or segmental pain relief in women receiving the air vs the saline method? Is there any difference in the incidence of adverse effects in women receiving air vs saline during the LOR technique? This was an experimental, prospective study with 50 women. Subjects were randomized to receive air or saline. The visual analogue scale was used to measure pain. A dermatome level recorded the spread of analgesia. No significant differences were found between groups for onset or quality of analgesia. There was a significant increase in the number of subjects who experienced segmental blocks after receiving air during the LOR technique.
Subject(s)
Air , Anesthesia, Epidural/methods , Anesthesia, Obstetrical/methods , Injections, Epidural/methods , Labor Pain/drug therapy , Sodium Chloride , Adolescent , Adult , Anesthesia, Epidural/instrumentation , Anesthesia, Epidural/nursing , Anesthesia, Obstetrical/instrumentation , Anesthesia, Obstetrical/nursing , Clinical Nursing Research , Epidural Space , Female , Humans , Injections, Epidural/adverse effects , Injections, Epidural/nursing , Labor Pain/diagnosis , Mid-Atlantic Region , Multivariate Analysis , Nurse Anesthetists , Nursing Assessment/methods , Pain Measurement , Patient Selection , Pregnancy , Prospective Studies , Sodium Chloride/administration & dosage , Syringes , Treatment OutcomeABSTRACT
BACKGROUND: To assess whether unilateral L2 infiltration with local anesthetic can be used to identify patients who will have negative discograms and thus eliminate the need for the discogram. Discogenic low-back pain is considered to have afferent pathways in the sinuvertebral nerves, mainly originating from the ventral rami of the spinal nerves. There is evidence that pain arising from the lower lumbar intervertebral discs may be transmitted through the sympathetic afferent fibers contained in the L2 spinal nerve root. Provocative discography, within the context of other clinical data, is the current "gold standard" by which to diagnose discogenic low-back pain, but a far more invasive procedure than L2 infiltration. OBJECTIVE: To evaluate the correlation between unilateral second lumbar (L2) spinal nerve root infiltration with local anesthetic and provocative discography in patients with chronic low back pain. STUDY DESIGN: A prospective, observational study. METHODS: All patients scheduled for discography were asked to participate in having local anesthetic infiltration of the L2 spinal nerve root at least two weeks prior to discography, until forty subjects were enrolled. Discography was performed after the patient's pain level returned to baseline. RESULTS: Local anesthetic infiltration of the L2 spinal nerve root was predictive of provocative discography results in only 46.5% of the subjects (26% true positives, and 20.5% true negatives). In 53.5% of the subjects, L2 infiltration was not predictive of discography results (20.5% false positives, and 33% false negatives). CONCLUSIONS: The results showed that unilateral L2 infiltration is not predictive of discogenic low-back pain when compared to discography, the current "gold-standard" for diagnosis.
