A Clinical Study for Comparison of Loss of Resistance Technique between EpiLOR® and Conventional Method for Identifying the Epidural Space
Abstract
Sandeep Singh Jadon, Jitendra Agrawal, Neha Parmar and Sourabh Shrivastav
Background: Accurate identification of the epidural space is essential for effective neuraxial anesthesia. The conventional loss of resistance (LOR) technique, although widely used, is highly subjective and operator-dependent. This study compares the conventional air- based LOR method with a novel device-assisted approach using the EpiLOR® system—a balloon-based syringe that provides visual confirmation of epidural space entry.
Methods: A prospective, randomized controlled trial was conducted on 60 patients undergoing elective gynecologic or orthopedic surgery under combined spinal-epidural anesthesia. Patients were randomized into two groups: Group C (conventional LOR) and Group EL (EpiLOR®). The primary outcomes were time to identify the epidural space and number of attempts. Secondary outcomes included ease of procedure, epidural depth, and incidence of accidental dural puncture (ADP).
Results: The time to identify the epidural space was significantly lower in Group EL (19.1 ± 5.2 seconds) than in Group C (41.1 ± 13.4 seconds; p < 0.00001). Although not statistically significant, Group EL showed fewer multiple and failed attempts. Ease of procedure was rated significantly better with EpiLOR® (1.7 ± 0.6 vs. 2.4 ± 1.1; p = 0.005). ADP occurred in 6.7% of patients in Group C and 0% in Group EL. No device-related adverse events were reported.
Conclusion: The EpiLOR® device demonstrated superior efficiency and procedural ease compared to the conventional LOR method, with a trend toward improved safety. These findings support the utility of visual-assist technologies in enhancing the accuracy and safety of epidural space identification.