Reinforcement of spinal anesthesia by epidural injection of saline: a comparison of hyperbaric and isobaric tetracaine

Yamazaki, Yutaka; Mimura, Mitsuko; Hazama, Kazuaki; Namiki, Akiyoshi

doi:10.1007/s005400050070

Cited by 15 publications

(10 citation statements)

References 5 publications

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“…[51920] In contrast, all of those using volumes larger than 7 mL resulted in successful block augmentation. [23171822] Herein, block augmentation was defined as a statistically significant increase in level of sensory block.…”

Section: Discussionmentioning

confidence: 99%

Minimum effective volume of normal saline for epidural volume extension

Tyagi

Kumar

Salhotra

et al. 2014

J Anaesthesiol Clin Pharmacol

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Background:Rescue strategies like changes in tilt of table are used to raise the level of an inadequate sensory block following intrathecal injection. Epidural volume extension (EVE) refers to an injection of normal saline through epidural catheter following an intrathecal block. It results in a rapid increase in the sensory level of subarachnoid block. Thus, it has been postulated that EVE may be used as a rescue strategy for an inadequate post-spinal sensory block. However, the minimum effective volume (MEV) of normal saline for EVE induced increase in level of spinal block has not been researched till date. We proposed to determine the MEV of normal saline required for EVE induced increase in post-spinal block sensory level.Materials and Methods:This prospective sequential allocation study was conducted in consenting adult males after institutional ethical committee approval scheduled for lower limb surgery under combined spinal epidural (CSE) anesthesia, who had an inadequate level of sensory block. Herein, an inadequate level was defined as lower than T10 at 10 min after the intrathecal injection, with no ascent for two consecutive readings taken 2 min apart. The EVE was performed with normal saline injected through epidural catheter, and was considered successful if the level of sensory block increased by two or more dermatomal segments within 5 min of the injection. The volume of normal saline for EVE was decided by using the up-and-down method, with the first patient receiving 10 mL and a dosing interval of 1 mL in subsequent patients. The analysis was done using the formula of Dixon and Massey, which enabled calculation of the MEV with 95% CI. Quantitative parametric data is represented as mean ± SD and nonparametric data as median (range).Results and Conclusion:The MEV of normal saline to raise the level of sensory block by two or more dermatomal segments within 5 min of EVE is 7.4 mL (95% CI: 5.5-9.9 mL).

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Section: Discussionmentioning

confidence: 99%

Minimum effective volume of normal saline for epidural volume extension

Tyagi

Kumar

Salhotra

et al. 2014

J Anaesthesiol Clin Pharmacol

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“…Several studies have shown an effect of EVE using saline by demonstrating an increased cephalad spread of the initial intrathecal injection, as shown in Table 1. [8][9][10][11][12][13][14] From these studies it does appear that injecting local anaesthetic or saline into the epidural space after spinal anaesthesia increases the spread of an intrathecal block.…”

Section: Block Extensionmentioning

confidence: 95%

“…Block extension has been shown to occur whether the spinal has been sited in the sitting [8][9][10]12 or lateral position. 11,31 It is also effective when using hyperbaric 8,11,12,14,31 or hypobaric 9,10,14 local anaesthetic for intrathecal injection.…”

Section: Technical Aspects Of Block Extensionmentioning

confidence: 96%

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Epidural volume extension and low-dose sequential combined spinal-epidural blockade: two ways to reduce spinal dose requirement for caesarean section

McNaught

Stocks

2007

International Journal of Obstetric Anesthesia

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“…Studies advocating the effect of EVE have compared saline volumes with analgesia durations affecting motor and sensory levels [5][6][7][8][9]. Lew et al…”

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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Reinforcement of spinal anesthesia by epidural injection of saline: a comparison of hyperbaric and isobaric tetracaine

Cited by 15 publications

References 5 publications

Minimum effective volume of normal saline for epidural volume extension

Minimum effective volume of normal saline for epidural volume extension

Epidural volume extension and low-dose sequential combined spinal-epidural blockade: two ways to reduce spinal dose requirement for caesarean section

Simultaneous combined spinal epidural anesthesia technique without catheter

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