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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