A prospective randomised comparative study between 10 ml and 15 ml of normal saline for epidural volume expansion on 10mg of 0.5% hyperbaric bupivacaine spinal anesthesia for elective infraumbilical surgeries in adult patients

Abstract

Introduction:The technique of combined spinal epidural (CSE) anaesthesia has become popular for patients undergoing elective infraumbilical surgeries where intraoperative prolonged and effective post-operative analgesia is required. CSE has the reliability of subarachnoid block as well as the flexibility of epidural block. The epidural volume expansion (EVE) technique is a modification of CSE in which the level of sensory analgesia obtained by subarachnoid block is increased by saline administered through the epidural catheter. Aims and Objectives: The present study was designed to compare different volumes of normal saline (10ml and 15ml) for epidural volume expansion on spinal anaesthesia with 10 mg (2 ml) of 0.5% hyperbaric bupivacaine for elective infraumbilical surgeries in adult patients with respect to sensory and motor block characteristics and haemodynamic stability. Materials and Methods: In this randomized, double blind, prospective study, ninety patients of ASA I and II of age group 18 -59 years undergoing elective infraumbilical surgeries were randomly assigned into three groups namely group 0, group 10 and group 15. Combined Spinal Epidural technique was performed using double segment technique in lateral position in all the patients. Group 0 received 10 mg of 0.5% hyperbaric Bupivacaine intrathecally without EVE, group 10 received 10mg of 0.5% hyperbaric Bupivacaine followed by EVE with 10 ml of normal saline, group 15 received 10mg of 0.5% hyperbaric Bupivacaine followed by EVE with 15 ml of normal saline. Results: There were no statistically significant difference in the demographic data among the studied groups. Regarding block profile, the time of onset of sensory block was found to be statistically insignificant whereas a significant difference was noted among the three groups regarding maximum level of sensory blockade. Time to achieve maximum level of sensory blockade was observed to be longest in group 15 (mean ± SD: 4.76 ±0.72 minutes) as compared to group 10 (mean ± SD: 4.60 ± 0.56 minutes) which was longer when compared to group 0 (4.26 ± 0.90 minutes) and was statistically significant (p=0.035). Time for two segment regression, time for complete sensory regression(s1) and total duration of analgesia were longest in group 10 (120 ± 21.21minutes, 204.50 ±32.35 minutes, 218.50 ±34.94 minutes respectively) as compared to group 15 (99.00 ± 17.43 minutes, 181.50 ±19.43 minutes, 209.00 ±18.02 minutes respectively) which was longer than group 0 (79 ± 14.81 minutes, 116.50 ± 22.17 minutes, 125.50 ± 24.11 minutes respectively).The parameters were statistically significant (p=0.000) among the groups. No statistically significant difference among the groups were observed with respect to time of onset of motor block and maximum motor blockade. The total duration of motor blockade was longer in group 10 (193.00 ± 32.65 minutes) as compared to group 15 (162.00 ± 15.45 minutes) and group 0 (106.00 ± 18.02 minutes). Hemodynamic stability was better in group 0 and group 10 when compared to group 15. Conc...

Evaluation of impact of epidural volume extension on the quality of spinal anaesthesia in patients undergoing proximal femoral nailing surgeries – randomized controlled study

“…Previously, the epidural volume extension technique has been used to reduce the dose of bupivacaine used in subarachnoid block using different volumes in either caesarean section patients [5] or infra-umbilical surgeries [6]. But there is a lack of availability of studies on the use of epidural volume extension in orthopaedic patients for PFN, which are also prone to hypotension and other complication related to spinal anaesthesia.…”