Pain physician
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Review
The BiP Test: a modified loss of resistance technique for confirming epidural needle placement.
Correct identification of the epidural space minimizes complications and ensures successful epidural blockade. The loss of resistance technique is the most common technique used for identification of the epidural space. However, sometimes loss of resistance occurs when the needle is not actually in the epidural space. The injection in this instance will result in the medication not being deposited in the epidural space. At other times, loss of resistance is not definitive. Further advancement of the needle may predispose to a wet tap. ⋯ This technique adds a useful confirmatory test to the already well-known loss of resistance technique used to verify the position of the epidural needle.
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Epidural steroid injections are commonly used for the treatment of radicular symptoms associated with symptomatic lumbar intervertebral disc herniations. Transforaminal epidural injections are believed to produce better clinical outcomes than interlaminar epidural injections. ⋯ In the current study, transforaminal epidural steroid injections for the treatment of symptomatic lumbar disc herniation resulted in better short-term pain improvement and fewer long-term surgical interventions than interlaminar epidural steroid injection.