Sensory Block Extension During Combined Spinal and Epidural

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

doi:10.1097/00115550-199823010-00017

Cited by 22 publications

(35 citation statements)

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“…This volume effect is abolished when patients are left seated for 5 minutes after spinal injection. 14 Other studies had contradicted this time dependency they found that raised sensory level can be found even epidural saline injection was given 20 minutes and 10 minutes after spinal block respectably. 15 Eileen et al showed that lower dose of 5 mg of intrathecal hyperbaric 0.5% bupivacaine with fentanyl 10µg followed by epidural volume extension (EVE) with 6 ml of 0.9% saline provide similar quality of anesthesia as that provided by higher dose of 9 mg of intrathecal hyperbaric 0.5% bupivacaine with fentanyl 10µg without EVE while allowing faster motor recovery of the lower limb.…”

Section: Discussionmentioning

confidence: 98%

Effect of epidural volume extension with colloid on dose requirement for intrathecal spinal block: a double blind prospective study

et al. 2016

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INTRODUCTIONCombined spinal-epidural anesthesia (CSEA) is gaining popularity as preferred technique for caeserean sections and orthopaedic surgeries as it has rapid onset through spinal component and extension of aneasthesia and postoperative pain relief through epidural component while avoiding disadvantage of both. [1][2][3] Epidural volume extension (EVE) is a modification of CSEA in which fluid is injected in epidural space through epidural catheter after intrathecal spinal block. The epidural space with colloids, which compress the subarachnoid space, causes cephalic spread of intrathecal local anaesthetic to increase block height and speed of onset (Volume Effect). 1,4 In contrast EVE with local anaesthetic causes leaks from epidural space to subarachnoid puncture and also perineural or transdural spread of the extradural solution to enhance intensity and block duration besides volume effect. [5][6][7] In this study, we aimed to evaluate the efficacy of epidural volume extension (EVE) with colloid on dose requirement of intrathecal bupivacaine with fentanyl to ABSTRACT Background: Epidural volume extension (EVE) is a modification of combined-spinal epidural anaesthesia (CSEA) in which fluid is injected in epidural space after the intrathecal block. Fluid in epidural space compress subarachnoid space and causes cephalic spread of intrathecal drug to increase block height. Purpose of study is to determine efficacy of EVE on dose requirement of intrathecal bupivacaine when colloid was used for EVE. Methods: Sixty patients of ASA physical status I or II, scheduled for elective caesarean sections were recruited and randomized into two groups (30 each group). Group 1: CSEA in which spinal block is followed by 10 ml Colloid (HES 6%) in epidural space; Group 2: CSEA but no fluid in epidural space. Onset of sensory block and hemodynamic variables were measured at 5 min. intervals up to 40 minutes then at 10 min. intervals till end of surgery. Ineffective block was top-up by epidural 0.5% bupivacaine in incremental doses. Results: Median effective dose of intrathecal bupivacaine was significantly lower, 4.0 mg (95% CI 4.40-5.60) in group 1 versus 7.0 mg (95% CI 6.93-7.61) in group 2. Only 11 patients required ephedrine in group 1 versus 20 in group 2. Requirement of ephedrine was significantly lower 2.20 (±2.94) mg in group 1 versus 4.0 (±2.88) mg groups 2. Changes in haemodynamic variables from baseline were significantly lower in group 1 than those in group 2. Conclusions: EVE with colloid was effective in lowering dose requirement of spinal bupivacaine while patients hemodynamically were more stable.

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Section: Discussionmentioning

confidence: 98%

Effect of epidural volume extension with colloid on dose requirement for intrathecal spinal block: a double blind prospective study

et al. 2016

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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%

“…Thirdly, Mardirosoff et al demonstrated that the effect of EVE is time sensitive [6]. While Loubert et al administered EVE immediately after the spinal bupivacaine injection, patients in the EVE group were kept in a sitting position during the injection which resulted in a longer procedural time (average 12.9 s), with a much wider SD.…”

mentioning

confidence: 99%

Epidural volume extension in combined spinal‐epidural anaesthesia

Lin¹,

Wu²,

Zhou³

2012

Anaesthesia

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“…This phenomenon has been demonstrated in clinical practice: Cephalad spread of sensory blockade after intrathecal injection of local anaesthetic (LA) is increased when LA or saline is injected into the epidural space soon after the intrathecal injection. [30][31][32][33] Cryomicrotome sectioning after epidural injection of ink, which by nature allows further distribution of injectate compared to myelography, has shown that solution injected into the epidural space spreads through numerous small channels between fat lobules, rather than a unified advancing front. 34 Therefore, the pattern of spread varies between the area close to the injection site and the margin of distribution, where fluid pressure is at its lowest.…”

Section: How Do Injected Solutions Spread Through the Epidural Space?mentioning

confidence: 99%

Thoracic Combined Spinal-Epidural (CSE) Anaesthesia

Lee

Zundert

Visser

et al. 2008

Southern African Journal of Anaesthesia and Analgesia

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The experimental delivery of spinal anaesthetics to the desired heights in the body, even above the termination of the spinal cord (thoracic level), has been shown to be potentially very valuable. Since there is no blockade of the lower extremities, little caudal spread, a significantly larger portion of the body experiences no venal dilation, and may offer a compensatory buffer to adverse changes in blood pressure intra-operatively. Further, the dosing of the anaesthetic is exceedingly low, given the highly specific block to only certain nerve function along a section of the cord. Thirdly, the degree of muscle relaxation achievable without central or peripheral respiratory or circulatory depression is superior to that with general anaesthesia.Results from Magnetic Resonance Imaging (MRI) studies indicate that the spinal cord lies anteriorly within its thecal boundaries in the apex of the thoracic curve. Intrathecal injections, therefore, at thoracic levels may have a greater absolute margin of error before needle contact with neural tissue -although the consequences of inadvertent contact are possibly more disastrous.The thoracic CSE technique has been practised in twelve patients with cardiovascular and/or pulmonary problems. Despite bad haemodynamic situations and/or severe end-stage lung problems, abdominal surgery (i.e. cholecystectomy, bowel and vascular surgery) could be performed successfully with the thoracic CSE method, with low impact on the patient. Anaesthetic care of the patients would have been more difficult, with consequently larger impacts on haemodynamic and pulmonary function, should these surgeries have occurred under general anaesthesia -the usual anaesthetic technique of choice.CSE techniques can be used in the thoracic region in patients who otherwise would receive general anaesthesia. High risk patients, with limited cardio-respiratory reserves, present challenges to the anaesthesiologist. Using the thoracic CSE technique in the thoracic space is extending the boundaries of regional anaesthesia.

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Sensory Block Extension During Combined Spinal and Epidural

Cited by 22 publications

References 0 publications

Effect of epidural volume extension with colloid on dose requirement for intrathecal spinal block: a double blind prospective study

Effect of epidural volume extension with colloid on dose requirement for intrathecal spinal block: a double blind prospective study

Epidural volume extension in combined spinal‐epidural anaesthesia

Thoracic Combined Spinal-Epidural (CSE) Anaesthesia

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