A Comparative Study Using the Balloon Indicator Syringe and Conventional Loss of Resistance (LOR) Syringe to Identify the Epidural Space in Adult Patients Undergoing Elective Lower Abdomen and Lower Limb Procedures – A Randomized Controlled Study

Abstract

Introduction: Neuraxial blocks, including spinal and epidural anaesthesia, are widely used for lower abdominal and limb surgeries because of reduced blood loss and prolonged analgesia. Epidural anaesthesia offers versatile intraoperative and postoperative pain management to improve accuracy and safety. This study aimed to assess the efficiency of the LOR balloon indicator syringe in successfully identifying the epidural space in terms of number of attempts.
Methods: This prospective comparative study was conducted on 292 patients at SRM Medical College Hospital, Chennai, for 18 months. Patients were randomised into Group C (n=146), who received epidural anaesthesia with a conventional LOR syringe, and Group B (n=146), who used an LOR balloon indicator syringe. All patients underwent preoperative evaluation, standard monitoring, and epidural anaesthesia using aseptic techniques. Epidural space identification was assessed on the basis of the number of attempts, time required, and complications.
Results: Group B required significantly fewer needle redirections and had more patients successfully identifying the epidural space on the first attempt (72.6%) than Group C (43.2%) (p=0.001). Complications were lower in Group B, with fewer cases of dural puncture (0.7% vs. 3.4%; p=0.036) and less bleeding (6.2% vs. 12.3%). The time to identify the epidural space was slightly shorter in Group B than in Group C (91.97±32.45 vs. 97.56±22.45; p=0.453). The heart rate, blood pressure, and oxygen saturation remained stable across both groups.
Conclusion: The LOR balloon syringe significantly reduced the number of attempts and time required to identify the epidural space compared with the conventional LOR syringe. It is easy to use, offers an objective method, and results in fewer complications than other methods.