534. New loss of resistance technique whether increase or decrease state trait anxiety inventory(STAI) levels: preliminary result V. Taspinar, O. Sacan, N. Yildiz, A. Postaci, B. Dikmen Ankara Numune Training and Research Hospital, Ankara, Turkey Background and Goal of Study: The loss of resistance(LOR) technique is used identify the epidural space(ES). The Episure Autodetect TM syringe(EAS) is a new LOR syringe which is a mod- ified Portex Pulsator TM LOR syringe with an internal compression spring, alleviating the need for operator thumb pressure.(1) This study evaluates when the residents performing the epidural space, whether use of Autodetect TM syringe increase or decrease State Trait Anxiety Inventory(STAI) levels.(2) Material/Method: After ethical committee approval and in- formed consent, 48 patients were included in this study. Twenty- four residents were informed about different features of epidural syringes (traditional or Autodetect TM syringe) and assessed with the STAI to obtain anxiety levels before placed epidural catheter. Epi- dural space was obtained in the sitting position, at interspace L3/4 or L4/5 using a 18G Tuohy needle by the residents either traditional syringe(GroupI) or Autodetect TM syringe(GroupII). LOR was de- tected using the Autodetect TM syringe or traditional syringe loaded with 3-5ml normal saline. After location of the epidural space, epidural catheter( Portex TM ) was placed. Data is recorded included patient demographics, LOR depth, number of attempts, time to locate the ES, the occurrence of false LOR, inadvertent dural punc- ture, intravascular placement, and failed blocks. Results are re- ported as meanstandard deviation. Mann-Whitney U, Chi- Square tests were used for statistical analysis. Results: Demographic data, ASA score, duration of operation were similar in both groups. The ES was identified in one attempt, the time needed to identify the ES was quicker with EAS(p0.006). We had one patient dural puncture in GroupI. STAI levels did not differ between the two groups(GroupI 336,GroupII 349). Conclusion: This objective LOR syringe may be useful as a teach- ing aid to demonstrate the principles of LOR. It could be a very useful addition to Anesthesia training, especially for residents. References 1- Riley ET: Anesth Analg 2007;105:1164-6 2- Akıncı SB: Anestezi Dergisi 2003;11:34-9 575. “To pull or not to pull” that is the question D. Mathur, A. Kabeer City Hospital, Anaesthetics, Birmingham, UK Background: We describe a case of epidural catheter breakage, following a neuraxial block for elective total hip replacement. Case Report: An elderly gentleman presented for a Total Hip Replacement. Combined Spinal Epidural was performed using Por- tex kit “needle-through-needle” technique with ease. Epidural was topped up once intra-operatively. Postoperatively, epidural infu- sion was met with occlusion. Flushing the catheter encountered resistance despite withdrawal, hence the infusion was disconnected and the patient was positioned laterally to remove the catheter. Limited spinal flexion was achieved due to hip brace. On pulling the catheter, resistance was met with at about 5 cm mark. Constant gentle traction was applied but catheter stretched and tip was sheared. In vitro catheter examination revealed that the last 5 cm of catheter had almost doubled in length. Catheter tip was not visualised on CT scan performed thereafter between 2 nd and 5 th lumbar levels. A repeat CT between 10 th thoracic and 2 nd lumbar levels revealed a foreign body in the epidural space. No focal neurology developed therefore conservative management was ad- vised by neurosurgeons. Discussion: Spinal spondylolytic changes can cause laceration of the catheter against periosteum. Review of literature suggests that some cases are associated with knotting of the catheter, although incidence of catheter breakage is approximately 1:20,000-30,000. Catheters have weak spots at perforations and can stretch up to 300%. Conclusion: The incidence of epidural catheter retention is rare but has to be dealt with caution. We recommend that insertion and removal should be performed in the same positions to minimise the possibility of catheter lodging on the periosteum. Radio-opaque catheters can be used to ease location. Ultrasound guidance can aid location when catheters are superficial, however, CT/MRI guidance with injection of radio-opaque dye is recommended to identify restrictions. 58 Posters • Central Nerve Blocks