Sensory block extension during combined spinal and epidural*1

Mardirosoff, Chahé; Dumont, Lionel; Lemédioni, Pascale; Pauwels, Patrick; Massaut, Jacques

doi:10.1016/s1098-7339(98)90117-1

Cited by 15 publications

(12 citation statements)

References 5 publications

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“…In most clinical trials on the subject of EVE conducted in nonobstetric patients, the volume of epidural injectate used is 10 mL;[781718] while in obstetric patients it ranges from 5[1920] to 10 mL. [25621] Higher volumes of 15 and 20 mL have also been evaluated in nonobstetric patients in a recent study in nonobstetric patients.…”

Section: Discussionmentioning

confidence: 99%

“…Given the constraints on operating room time, 10 min seemed a reasonable time limit prior to attempting block augmentation with a rescue strategy such as EVE. It is also known that EVE is a time dependent phenomenon[723] and gives best results if applied early after an intrathecal injection. Mardirosoff and coworkers[7] showed that for EVE to be effective, the patient should be laid supine within 5 min of completing intrathecal injection.…”

Section: Discussionmentioning

confidence: 99%

“…It is also known that EVE is a time dependent phenomenon[723] and gives best results if applied early after an intrathecal injection. Mardirosoff and coworkers[7] showed that for EVE to be effective, the patient should be laid supine within 5 min of completing intrathecal injection. Trautman et al .,[23] showed it to be ineffective when performed 20 min after the intrathecal injection.…”

Section: Discussionmentioning

confidence: 99%

“…[4] However, the minimum effective volume (MEV) of normal saline required to produce a rapid increase in the sensory level has not been investigated. In previously published studies on the subject of EVE, the volume of normal saline used for EVE ranges from 5 to 20 m,[3567] but there is very little data comparing the effect of various volumes of normal saline on the sensory block level per se . [38]…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Minimum effective volume of normal saline for epidural volume extension

Tyagi

Kumar

Salhotra

et al. 2014

J Anaesthesiol Clin Pharmacol

View full text Add to dashboard Cite

show abstract

“…[234] This effect of injecting epidural saline is time limited and injecting saline will have no effect on the block profile, after 30 min or once two segment regression has begun. [56] This was the reason that we had opted to inject 8 mL of normal saline 5 min after intrathecal injection. This technique proved to have a faster motor recovery profile by at least 60 min.…”

Section: Discussionmentioning

confidence: 99%