Combined Spinal-Epidural Anesthesia Using Epidural Volume Extension Leads to Faster Motor Recovery After Elective Cesarean Delivery: A Prospective, Randomized, Double-Blind Study

Lew, Eileen; Yeo, S N; Thomas, E.

doi:10.1213/01.ane.0000101987.79454.bc

Cited by 90 publications

(80 citation statements)

References 20 publications

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“…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. 16 As many previous studies supported the dose lowering effect of EVE of our study but Beagle et al who found that EVE has no significant or reliable dose lowering effect on intrathecal dose of bupivaciane. 17 This could be a result of small sample size chosen in this study (30 cases in each group) with only 50% achieving effective dose.…”

Section: Discussionsupporting

confidence: 65%

“…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: Discussionsupporting

confidence: 65%

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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“…Using EVE with saline, small-dose spinal block can be extended to provide adequate anesthesia for cesarean delivery 4 . Several mechanisms were reported to play a role in the enhancement of spinal block by EVE with saline, including the volume effect, in which the theca is compressed by epidural saline, resulting in the squeezing of cerebrospinal fl uid and more extensive spread of subarachnoid local anesthetic 5,6,8,12 .…”

Section: Discussionmentioning

confidence: 99%

“…The spinal component provides rapid onset of anesthesia and the drugs that are administered through the catheter placed in the epidural space maintain analgesia during the postoperative period 1 . The epidural volume extension (EVE) technique is a modifi cation of CSEA in which the level of sensory analgesia obtained via subarachnoid block is increased by a small volume of saline or local anesthetic administered through the epidural catheter [2][3][4][5][6] . The level of sensory block obtained is not only related to the analgesic effect of the local anesthetic administered into the epidural space, but to the effect of the volume of the epidural solution causing cephalic movement of the local anesthetic in the subarachnoid space 5,[7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

O bloqueio combinado raqui-peridural com extensão do volume peridural causa nível mais alto de bloqueio do que a raquianestesia com dose única

Salman¹,

Kayacan²,

Ertuğrul³

et al. 2013

Rev. Bras. Anestesiol.

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Background and objectives: We evaluated the effects of epidural injection with levobupivacaine or serum physiologic, epidural volume extension (EVE), when using combined spinal-epidural anesthesia (CSEA) for cesarean delivery. Methods: One-hundred and thirty-eight patients with a full-term pregnancy of 37-42 weeks that were scheduled for cesarean delivery were included. Group 1 (n = 48) received single-shot spinal anesthesia (SSS), group 2 (n = 45) received CSEA-EVE with saline, group 3 received CSEA-EVE with levobupivacaine. The characteristics of motor and sensory block, the effects on maternal hemodynamic changes and the effects on the newborn were compared. Results: Time to reach maximum sensory block was signifi cantly shorter in groups 3 than in group 1 and 2 (p < 0.05). Two-segment regression time of sensory block was signifi cantly shorter in group 1, whereas it was signifi cantly longer in group 3 than in group 2 (p < 0.05). Time to onset of motor block was signifi cantly longer in group 1 than in groups 2 and 3 (p < 0.05). Time to reach maximum motor block was signifi cantly shorter in group 3 than in groups 1 and 2 (p < 0.05). Time to recovery of motor block was signifi cantly longer in group 3 than in groups 1 and 2 (p < 0.05). The time to fi rst analgesic was signifi cantly longer in group 3 (p < 0.05). Conclusions: Suffi cient and rapid motor and sensory block was achieved in all the patients in the present study; however, motor and sensory block had faster onset, lasted longer, and was of a higher level in groups 2 and 3; these effects were more pronounced in the group 3.

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“…The combined sequential spinal epidural (CSSE) technique has been studied mostly for cesarean section, and it may be advantageous as well in other high-risk patients such as very old urologic patients, by increasing the safety of the central regional block . 6,19,20,21,22 Doses and concentrations of local anesthetic used for CSSE are of great importance in determining the clinical management of this technique, and local anesthetic pharmacodynamics and pharmacokinetic profile can influence CSSE outcome: recently Levobupivacaine emerged in regional anesthesia as a safer alternative to other local anesthetics, including its racemic parent bupivacaine, since it demonstrated less affinity and reduced depressant effects onto myocardial and central nervous vital centers in pharmacodynamics studies, and a superior pharmacokinetic profile 23 . Actually, CSSE with intrathecal dose of bupivacaine as low as 5 mg has been found to allow good surgical anesthesia in cesarean delivery 24 .…”

mentioning

confidence: 99%

Study -“Comparative Study of Combined Spinal Epidural Versus Epidural Anaesthesia in Lower Limb Surgeries And Lower Abdominal Surgeries ”

Sundar¹,

Mundwadkar²

2017

IOSR JDMS

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Combined Spinal-Epidural Anesthesia Using Epidural Volume Extension Leads to Faster Motor Recovery After Elective Cesarean Delivery: A Prospective, Randomized, Double-Blind Study

Abstract: When compared with conventional, single-shot spinal anesthesia, epidural volume extension of a small-dose spinal block provides satisfactory anesthesia for cesarean delivery with only 55% of the bupivacaine dose required and is associated with faster motor recovery of the lower limbs.

Cited by 90 publications

References 20 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

O bloqueio combinado raqui-peridural com extensão do volume peridural causa nível mais alto de bloqueio do que a raquianestesia com dose única

Study -“Comparative Study of Combined Spinal Epidural Versus Epidural Anaesthesia in Lower Limb Surgeries And Lower Abdominal Surgeries ”

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