you are mistaken sir, i have use either air or saline with lor (depends on the syringe in the kit). 2-5 cc of air is benign. i have placed many, many, many epidurals with either air or saline lor technique.
if it were so dangerous, i don't believe anesthesia and analgesia would have printed this article:
the median effective dose of intrathecal hyperbaric bupivacaine is larger in the single-shot spinal as compared with the combined spinal-epidural technique
raymond wee-lip goy, mmed anesthesia, fanzca, yoong chee-seng, mmed anesthesia, fams, alex tiong-heng sia, mmed anesthesia, koay choo-kok, mmed anesthesia, fanzca, fams, and shen liang, msc
department of anesthesia and intensive care, changi general hospital, singapore
address correspondence and reprint requests to raymond wee-lip goy, mmed anesthesia, fanzca, department of anesthesia, national university hospital, 5 lower kent ridge rd., singapore 119074. address e-mail to firstname.lastname@example.org . the combined spinal-epidural technique (cse) has been associated with prolonged motor recovery and more frequent arterial hypotension as compared with a single-shot spinal (sss) technique. we determined the median effective dose (med) of intrathecal hyperbaric bupivacaine for cse and sss by using the up-down sequential allocation technique. sixty male patients were randomly allocated to receive intrathecal administration through an sss or cse technique. needle insertion occurred at the l3-4 interspace in all patients. in sss, 9.5 mg of hyperbaric bupivacaine was administered through a 27-gauge whitacre spinal needle. in cse, a 17-gauge tuohy needle with 4 ml of air was used to locate the epidural space, through which a 27-gauge whitacre spinal needle was introduced and 7.0 mg of hyperbaric bupivacaine was administered. the dosing adjustment was 0.5 mg. a "successful" outcome was arbitrarily defined as sensory anesthesia at or above the t6 dermatome lasting for 60 min. a "success" resulted in a 0.5-mg decrement, whereas a "failure" resulted in a 0.5-mg increment in the next patient. there were 13 successes in both groups. the med of bupivacaine was 9.18 mg (95% confidence interval, 8.89-9.47 mg) for cse as compared with 11.37 mg (95% confidence interval, 10.88-11.86 mg) for sss (p