The Effect of Epidural Saline Injection on Analgesic Level During Combined Spinal and Epidural Anesthesia Assessed Clinically and Myelographically

Takiguchi, Tetsuo; Okano, Takatoshi; Egawa, Hirotoshi; Okubo, Yoshinori; Saito, Kyoko; Kitajima, Toshimitsu

doi:10.1097/00000539-199711000-00024

Cited by 74 publications

(74 citation statements)

References 11 publications

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“…Study demonstrated that the contrast medium in the subarachnoid space was displaced in a cephalad direction after the lumber epidural injection of saline and that the diameter of the subarachonoid space narrowed due to the volume effect. 13 It was suggested that volume effect is time dependent and is seen when epidural top up is done soon after spinal injection. This volume effect is abolished when patients are left seated for 5 minutes after spinal injection.…”

Section: Discussionmentioning

confidence: 99%

“…They thought this is unlikely as other studies had demonstrated the effect with lower dose of EVE only 5 ml and 6 ml EVE. 13,16 To avoid these bias we had selected a dose of 10 ml and colloid (6% HES) in place of crystalloid. As previous studies showed that colloid has more viscosity, absorbed slowly so may be more effective than crystalloid as EVE for enhancing spinal block.…”

Section: Discussionmentioning

confidence: 99%

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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: 99%

Section: Discussionmentioning

confidence: 99%

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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“…Daha önce yapılan çalışmalarda da bildirildiği üzere KSEB uygulamasında düşük doz lokal anestezik ajan uygulanarak hızla spinal blok sağlanabilir ve daha sonra epidural ek dozlar ile duyusal blok seviyesi istenilen segmentlere genişletilebilir. [9][10][11][12] KSEB'de düşük doz lokal anestezik ile yeterli blok seviyesine ulaşılması-nın nedeni olarak, epidural aralığa girildiğinde epidural basıncın atmosferik basınca ulaştığını ve dolayısıyla serebrospinal sıvının volüm ve dolaşımını etkileyerek lokal anesteziğin daha iyi yayılımına neden olacağını belirtilmiştir. [13,14] Goy ve ark.…”

Section: Discussionunclassified

Comparison of the maternal and neonatal effects of combined spinal-epidural block and spinal block for cesarean section

Uysallar¹,

Karaman²,

Günüşen³

et al. 2011

Agri

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Summary Objectives: Combined spinal-epidural block (CSEB) has gained increasing interest as it combines the reliability of a spinal block (SB) ÖzetAmaç: Sezaryen operasyonlarında spinal bloğun güvenirliliği ve epidural bloğun kullanım esnekliklerini içeren kombine spinal-epidural bloğun kullanımı giderek artmaktadır (KSEB). Biz çalışmamızda KSEB ile spinal bloğun maternal ve fetal etkilerini karşılaştırmayı amaçladık. Gereç ve Yöntem: Miyadında 40 gebe randomize olarak iki gruba ayrıldı. KSEB grubuna intratekal 1.5 ml, spinal blok (SB) grubuna 2.5 ml %0.5 hiperbarik bupivakain uygulandı. KSEB grubunda bloğun uygulanmasından itibaren 10 dakika geçme-sine rağmen duyusal blok T4' e ulaşmamış ise epidural kateterden her bloke olmayan segment için 2 mL %0.5 bupivakain ilave edildi. Maternal hemodinamik etkiler, intraoperatif anestezi kalitesi ve yan etkiler, Apgar ve NAKS skorları ve postoperatif analjezi yönünden iki grup karşılaştırıldı. Bulgular: Duyusal bloğun T4' e ulaşma zamanı ve tam blok oluşma süresi SB grubunda KSEB' a göre istatistiksel olarak kısa saptandı (p<0.05). Ortalama arter basıncı ve kalp atım hızı SB grubunda düşük saptandı (p<0.05). Umblikal kord kan gazı değerleri, Apgar skoru, NAKS ve bulantı, kusma gibi yan etkiler açısından farklılık görülmedi. Sonuç: Hem spinal hem KSEB iyi bir cerrahi analjezi sağlamıştır. Maternal hipotansiyon her iki teknik için de risk olmakla birlikte, spinal blok ile daha erken ve derin olmaktadır. Maternal kan basıncının dikkatli monitörizasyonundan ve hipotansiyonun hemen tedavi edilmesinden dolayı neonatal açıdan fark saptanmamıştır.Anahtar sözcükler: Kombine spinal-epidural blok; spinal blok; sezaryen.

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“…The literature suggests a strongest effect of epidural volume extension (EVE), in a volume-dependant fashion, in the non-obstetrical population receiving plain bupivacaine [2,3]. In term parturients, factors such as hormone-induced hypersensitivity to neuraxial-administered local anaesthetics, epidural venous plexus engorgement, the baricity of the injected local anaesthetic and the position of the patient may significantly affect the height of the spinal block.…”

Section: A Replymentioning

confidence: 99%

Epidural volume extension in combined spinal‐epidural anaesthesia

Lin¹,

Wu²,

Zhou³

2012

Anaesthesia

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The Effect of Epidural Saline Injection on Analgesic Level During Combined Spinal and Epidural Anesthesia Assessed Clinically and Myelographically

Abstract: In this study, using surgical patients and volunteers, we determined that a lumbar epidural injection of physiological saline solution 10 min after spinal anesthesia produces a higher analgesic level than spinal anesthesia alone because of a volume effect.

Cited by 74 publications

References 11 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

Comparison of the maternal and neonatal effects of combined spinal-epidural block and spinal block for cesarean section

Epidural volume extension in combined spinal‐epidural anaesthesia

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