Epidural volume expansion: is there a ceiling effect?

Doganci, N.; Apan, Alparslan; Tekın, Özlem Moraloğlu; Kaymak, Çetin

doi:10.1097/00115550-200709001-00053

Cited by 12 publications

(34 citation statements)

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“…It is possible that this volume was insufficient to cause a higher spread of local anaesthetic. Other investigators have shown that the epidural volume extension effect is independent of the epidural volume injected [13, 14]. There is evidence of greater compression of the dural sac and decreasing CSF volume with increasing epidural volume injection [15].…”

Section: Discussionmentioning

confidence: 99%

Epidural volume extension in combined spinal epidural anaesthesia for elective caesarean section: a randomised controlled trial

Loubert¹,

O’Brien

Fernando

et al. 2011

Anaesthesia

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SummaryWe investigated the effect of epidural volume extension on spinal blockade in pregnant women undergoing elective caesarean section with a combined spinal-epidural technique. We randomly allocated 90 healthy subjects to three groups to receive spinal hyperbaric bupivacaine 7.5 mg (group B7.5), spinal hyperbaric bupivacaine 7.5 mg immediately followed by epidural volume extension with saline 5 ml (group B7.5-EVE) or spinal hyperbaric bupivacaine 10 mg without epidural volume extension (group B10). We evaluated the height of the block every 5 min for 15 min following the spinal injection. The overall sensory block level increased with time (p < 0.001), regardless of the group studied, and there were significantly fewer failures of block in the group B10 compared with both B7.5 and B7.5-EVE groups (p = 0.001). In conclusion, we could not demonstrate a benefit in using epidural volume extension with 5 ml saline as part of a combined spinal epidural technique in term parturients undergoing elective caesarean section. The combined spinal-epidural anaesthesia (CSE) technique for caesarean section is popular in some obstetric units [1], combining the rapid onset and intensity of subarachnoid block with the added advantage of an indwelling epidural catheter, which allows perioperative extension of anaesthesia. It has been shown that intrathecal local anaesthetics spread more rostrally following epidural volume extension (EVE) compared to a control group without epidural volume extension [2]. The mechanism by which epidural volume extension increases the rostral spread of intrathecal local anaesthetic is not fully understood. Previous studies have demonstrated that the increase in maximal level of sensory blockade after epidural volume extension is due to compression of the dural sac by the fluid in the epidural space, causing rostral spread of local anaesthetic already present in the subarachnoid space [3,4]. Our study aimed to examine the effect of epidural volume extension on intrathecal blockade in women presenting for caesarean section under CSE anaesthesia. We hypothesised that in this population, a low-dose subarachnoid block augmented by epidural volume extension would provide a similar sensory block height and success rate in comparison to a higher dose spinal anaesthetic, while reducing the incidence of maternal hypotension.

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Section: Discussionmentioning

confidence: 99%

Epidural volume extension in combined spinal epidural anaesthesia for elective caesarean section: a randomised controlled trial

Loubert¹,

O’Brien

Fernando

et al. 2011

Anaesthesia

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“…Lin et al suggest at least 10 ml of epidural saline. Takiguchi et al [7] and Dogancı et al [13] suggest 10-15 and 20 ml of epidural saline for EVE. In EVE, there are studies suggesting the block level is time-dependent and it has been determined that the average block resistance time is 12 minutes [14].…”

Section: Discussionmentioning

confidence: 99%

Simultaneous combined spinal epidural anesthesia technique without catheter

Erel¹

2018

Eu Clin Anal Med

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Aims: The extension of spinal anesthesia by extradural injection has been identified as a modification of the combined spinal-epidural anesthesia. Epidural volume extension (EVE) is a rescue strategy that can raise the level of insufficient post-spinal sensory block. Material and Method: After approval of Adnan Menderes University Ethics Committee (Decision 2016/834/37), the data of 455 patients who had undergone insufficient simultaneous combined spinal epidural without catheter between 2010 and 2016 were retrospectively analyzed in terms of ASA scores; demographic and hemodynamic data; surgery type; preoperative and postoperative sensory and motor block levels; operation onset times after anesthesia; need for peroperative additional anesthesia, vasopressor (ephedrine) and atropine; and postoperative pain onset times. Results: Of the 455 patients, there were two groups. In the first group, there were 238 patients who had undergone cesarean section and in the second group there were 217 patients who had undergone surgery for inguinal hernia. There was no mortality and morbidity in any group. There was a statistically significant decrease in heart rate, systolic, diastolic, and mean arterial pressures during the peroperative period in both groups (p<0.05). Discussion: The simultaneous combined spinal-epidural technique (sCSEA) without catheter may be considered as an alternative to conventional methods for appropriate surgeries. It can be safely used with local anesthetic combinations instead of saline for EVE. The advantages and disadvantages of EVE compared to the conventional method should be demonstrated with clinical randomized studies.

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“…It is possible that EVE has a negligible effect on spinal block height and other characteristics compared with these factors. This is indirectly supported by the fact that few studies suggest an EVE effect (even with close to 10 ml EVE) on the height and duration of block in parturients undergoing spinal anaesthesia [4][5][6]. Moreover, even when EVE with saline significantly raised the sensory level in one study, it did not reduce the need for intra-operative supplementation nor increase the success rate of spinal anaesthesia [7].…”

Section: A Replymentioning

confidence: 99%

“…Using hyperbaric contrast medium, Takiguchi et al demonstrated three segments of myelographic cephalad extension after EVE using 20 ml, with the patient in a 45°reverse Trendelenburg position [2], although some of this extension was likely to be attributable to the diffusion characteristics of contrast medium [3]. Doganci et al demonstrated a ceiling effect using EVE with 15 ml after normobaric bupivacaine administration [4].…”

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confidence: 99%