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Air versus saline in the loss of resistance technique for the identification of the epidural space: systematic review of randomized clinical trials

Grant number: 13/12269-4
Support type:Scholarships in Brazil - Scientific Initiation
Effective date (Start): September 01, 2013
Effective date (End): August 31, 2014
Field of knowledge:Health Sciences - Medicine - Surgery
Principal researcher:Regina Paolucci El Dib
Grantee:João Vitor Pereira Doles
Home Institution: Faculdade de Medicina (FMB). Universidade Estadual Paulista (UNESP). Campus de Botucatu. Botucatu , SP, Brazil


The success of epidural anaesthesia depends on the correct identification of the epidural space. For several decades, the choice between using either air or physiological saline to identify the epidural space has been governed by the personal experience of the anaesthesiologist. Epidural block remains one of the main regional anaesthesia techniques. It is used for surgical anaesthesia, obstetric analgesia, postoperative analgesia, the treatment of chronic pain and to complement general anaesthesia. With regards to recent clinical trials, the studies show some advantages from either technique (saline or air) and each author have demonstrated their own preference concerning the loss of resistance technique. However, the ideal technique for identifying the epidural space remains unclear. The research project will be conducted in the Department of Anesthesiology and at the Systematic Review Unit of the Botucatu Medical School/ UNESP - Botucatu-SP. It will be performed a systematic review according to the Cochrane Collaboration methodology aiming to map all RCTs identified in the electronic databases to evaluate the efficacy of air in the loss of resistance technique for the identification of the epidural space. The following databases will be searched: Pubmed, CENTRAL (the Cochrane Library), Embase and Lilacs. The analysis and data collection will be performed by two reviewers independently, who will select potential studies. The protocol of this systematic review is already published in the Cochrane Anaesthesia Group of the journal the Cochrane Database of Systematic Review, with an impact factor of 5.9.

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