Effect of epidural saline washout on regression of sensory and motor block after epidural anaesthesia with 2% lidocaine and fentanyl in elderly patients

Abstract

SummarySeventy elderly males received lumbar epidural anaesthesia with 12 ml of 2% lidocaine containing fentanyl 50 lg. At the end of transurethral surgery, the washout group (n = 33) received an epidural bolus of 30 ml saline while the control group (n = 34) did not. Mean (SD) times to 1-grade (17.2 (11.9) vs 32.7 (11.3) min) and 2-grade regression (23.8 (12.2) vs 56.0 (23.9) min) of motor block, 3-dermatomal sensory regression (31.4 (11.6) vs 42.2 (14.4) min for cold and 30.8 (15.6) vs 40.6 (14.2) min for pinprick), and regression to S1 (57.7 (16.1) vs 76.2 (20.2) min for cold and 56.8 (17.3) vs 69.2 (16.2) min for pinprick) were significantly shorter in the washout group than the control group. There were no differences in postoperative pain scores and side effects between the two groups. We concluded that epidural washout facilitates regression of both motor and sensory block following epidural anaesthesia without reducing the postoperative analgesic benefit.

Effect of Normal Saline Bicarbonate on Reversing Epidural Anesthesia Either with Bupivacaine Or Bupivacaine and Nalbuphine in Patients Undergoing Orthopedic Surgery

“…According to the VAS the first analgesic requirement is the same in groups A, B, and C. Our study demonstrates no wash occurring in nalbuphine because nalbuphine-like fentanyl is lipophilic that it sticks to fatty compartments found in the epidural space and not affected by hydrophilic washout saline. These results were similar to that of Park et al [6] who reported that epidural saline washout does not affect the epidural fentanyl injection.…”

“…Similarly, Park et al [6] reported that a 30 mL bolus of saline hastened motor and sensory recovery in elderly men who received 12 mL of 2% lidocaine with 50 g of fentanyl epidurally for transurethral surgery.…”

“…Resolution of epidural anesthesia depends on the redistribution of local anesthetics from neural tissues and its elimination by systemic uptake. Redistribution can be enhanced by decreasing the concentration of residual local anesthetics in the epidural space [6]. Increasing the speed of recovery from epidural anesthesia will improve patient acceptance of epidural anesthesia as well as potential cost savings and decease risk of prolonged recumbence [7].…”

Paravertebral Block with Compound Betamethasone in Laparoscopic Cholecystectomy: A Double-blind Randomized Controlled Trial

“…This combination of betamethasone is FDA approved, albeit for other indications than peripheral nerve block [3]. This combination of betamethasone has been used successfully in other peripheral nerve blocks such as great occipital nerve block [24], which was endorsed by the American Headache Society [4, 22]. This combination of betamethasone together with ropivacaine has been used safely in brachial plexus interscalene block [5,20].…”

“…In this randomized, double-blind, controlled study of LC patients, we specifically investigated the effects of unilateral TPVB with or without adjuvants, combination of non-particulate and particulate betamethasone, versus surgeon infiltration at port sites, on blockade duration, pain control and other patient-centered perioperative outcomes. The regression of sensory block, an important factor for analgesia duration, was well studied in epidural anesthesia [3, 4], but nearly none was documented in paravertebral block. Our hypotheses were: (1) Perineural administration of betamethasone together with local anesthetic would prolong the duration of TPVB blockade; and (2) TPVB would provide superior post-operative analgesia as compared to surgeon infiltration.…”