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Epidural Pain Free Hypertonic Saline Volumes And Concentrations

Gabor B Racz on May 29, 2018 at 2:37 pm
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    • Gabor B RaczGabor B Racz
      Joined: Mar 28, 2016
      Posts: 30

      Epidural Pain Free Hypertonic Saline Volumes And Concentrations.

      Reduction Of Pain And Post Procedure Observations Lead To Large Economic Impact And Patient Acceptance.

      Common concern has been painful hypertonic saline (HS) injection. Evidence shows HS behaves similar to local anesthetic which produce reversible interference with nerve conduction. Also HS inhibits fibroblast regeneration and block small C pain fibers and result in long lasting pain relief. It should only be injected through a catheter, never in the mid-line that could cause subdural osmotic volume expansion, compressing blood supply.

      The recommendation is to use small volume (1 – 1.5 ml) 1% lidocaine just prior to the NEW 0.6% lidocaine 10% HS mixture.
      The second and third injections, before the HS  concentration of local anesthetic is reduced to avoid a motor block and the need for LONG 3 to 4 hours of observation. The reduced concentration of local anesthetic and HS interacts and causes less motor block resulting in rapid recovery and early ambulation to be ready for discharge. This observation reduces the cost of manpower and patients love the “NO PAIN” technique.

      • Mohd Shahir AnuarMohd Shahir Anuar
        Joined: Feb 23, 2017
        Posts: 1

        Is normal saline also Pain Free Dr Gabor?

        • Gabor B RaczGabor B Racz
          Joined: Mar 28, 2016
          Posts: 30

          Yes Normal Saline is pain free in the epidural space.

          However it does not make the Hypertonic Saline pain free.

          Distilled or Non-ionic water on the other hand is quite painful in the the epidural space, believed to irritate the small C Fibers.

          In the subarachnoid space it is not painful. When I was a boy we used distilled water for the loss of resistance technique and gave it up because of the pain it caused to the patient.

          Being pain free is important!

          Dr. Gabor B. Racz

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