Epidural Volume Extension: A Review

Tyagi, Asha; Sharma, Chhavi; Kumar, Sunil; Sharma, Deborshi; Jain, A K; Sethi, Ankur

doi:10.1177/0310057x1204000405

Cited by 20 publications

(14 citation statements)

References 49 publications

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“…Thus EVE may be used as a rescue strategy to raise the level of an inadequate post-spinal sensory block. [4] However, the minimum effective volume (MEV) of normal saline required to produce a rapid increase in the sensory level has not been investigated. In previously published studies on the subject of EVE, the volume of normal saline used for EVE ranges from 5 to 20 m,[3567] but there is very little data comparing the effect of various volumes of normal saline on the sensory block level per se .…”

Section: Introductionmentioning

confidence: 99%

Minimum effective volume of normal saline for epidural volume extension

Tyagi

Kumar

Salhotra

et al. 2014

J Anaesthesiol Clin Pharmacol

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Background:Rescue strategies like changes in tilt of table are used to raise the level of an inadequate sensory block following intrathecal injection. Epidural volume extension (EVE) refers to an injection of normal saline through epidural catheter following an intrathecal block. It results in a rapid increase in the sensory level of subarachnoid block. Thus, it has been postulated that EVE may be used as a rescue strategy for an inadequate post-spinal sensory block. However, the minimum effective volume (MEV) of normal saline for EVE induced increase in level of spinal block has not been researched till date. We proposed to determine the MEV of normal saline required for EVE induced increase in post-spinal block sensory level.Materials and Methods:This prospective sequential allocation study was conducted in consenting adult males after institutional ethical committee approval scheduled for lower limb surgery under combined spinal epidural (CSE) anesthesia, who had an inadequate level of sensory block. Herein, an inadequate level was defined as lower than T10 at 10 min after the intrathecal injection, with no ascent for two consecutive readings taken 2 min apart. The EVE was performed with normal saline injected through epidural catheter, and was considered successful if the level of sensory block increased by two or more dermatomal segments within 5 min of the injection. The volume of normal saline for EVE was decided by using the up-and-down method, with the first patient receiving 10 mL and a dosing interval of 1 mL in subsequent patients. The analysis was done using the formula of Dixon and Massey, which enabled calculation of the MEV with 95% CI. Quantitative parametric data is represented as mean ± SD and nonparametric data as median (range).Results and Conclusion:The MEV of normal saline to raise the level of sensory block by two or more dermatomal segments within 5 min of EVE is 7.4 mL (95% CI: 5.5-9.9 mL).

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Section: Introductionmentioning

confidence: 99%

Minimum effective volume of normal saline for epidural volume extension

Tyagi

Kumar

Salhotra

et al. 2014

J Anaesthesiol Clin Pharmacol

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show abstract

“…The advantage in EVE lies in its ability to combine the rapidity, density, and reliability of the subarachnoid block with the flexibility of continuous epidural block to titrate a desired sensory level, vary the intensity of the block, control the duration of anaesthesia and deliver postoperative analgesia. 5 But regarding the disadvantage of EVE, Metaregression showed a significant result, increase in volumes of epidural volume extension leading to higher maximum sensory spread and a higher number of patients becoming hypotensive. 6 Various mechanisms have been described to explain the rapid extension of sensory block that occurs with EVE include a 'volume effect', 'drug effect' and augmentation of a pre-existing area of subclinical analgesia.…”

Section: Discussionmentioning

confidence: 99%

“…Imaging studies documented thecal compression following EVE and several studies demonstrate an increase in post spinal sensory block following epidural injection of normal saline. 5 Hence the study was undertaken to compare the effects of two different volumes (10 ml and 15ml) of normal saline for epidural volume expansion on spinal block characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…4 Among various mechanisms described, the most commonly extended explanation is the thecal compression due to the 'volume effect' on the consequent epidural injection of fluid. 5 Various volumes of normal saline (5ml, 10ml, 15ml and 20mL) have been used for EVE technique but there is no consensus regarding the effective volume of normal saline for epidural volume expansion on the sensory and motor block characteristics of spinal anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

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A prospective randomised comparative study between 10 ml and 15 ml of normal saline for epidural volume expansion on 10mg of 0.5% hyperbaric bupivacaine spinal anesthesia for elective infraumbilical surgeries in adult patients

Singh¹,

Vijayalakshmi²,

Kattishettar³

2019

IJCA

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Introduction:The technique of combined spinal epidural (CSE) anaesthesia has become popular for patients undergoing elective infraumbilical surgeries where intraoperative prolonged and effective post-operative analgesia is required. CSE has the reliability of subarachnoid block as well as the flexibility of epidural block. The epidural volume expansion (EVE) technique is a modification of CSE in which the level of sensory analgesia obtained by subarachnoid block is increased by saline administered through the epidural catheter. Aims and Objectives: The present study was designed to compare different volumes of normal saline (10ml and 15ml) for epidural volume expansion on spinal anaesthesia with 10 mg (2 ml) of 0.5% hyperbaric bupivacaine for elective infraumbilical surgeries in adult patients with respect to sensory and motor block characteristics and haemodynamic stability. Materials and Methods: In this randomized, double blind, prospective study, ninety patients of ASA I and II of age group 18 -59 years undergoing elective infraumbilical surgeries were randomly assigned into three groups namely group 0, group 10 and group 15. Combined Spinal Epidural technique was performed using double segment technique in lateral position in all the patients. Group 0 received 10 mg of 0.5% hyperbaric Bupivacaine intrathecally without EVE, group 10 received 10mg of 0.5% hyperbaric Bupivacaine followed by EVE with 10 ml of normal saline, group 15 received 10mg of 0.5% hyperbaric Bupivacaine followed by EVE with 15 ml of normal saline. Results: There were no statistically significant difference in the demographic data among the studied groups. Regarding block profile, the time of onset of sensory block was found to be statistically insignificant whereas a significant difference was noted among the three groups regarding maximum level of sensory blockade. Time to achieve maximum level of sensory blockade was observed to be longest in group 15 (mean ± SD: 4.76 ±0.72 minutes) as compared to group 10 (mean ± SD: 4.60 ± 0.56 minutes) which was longer when compared to group 0 (4.26 ± 0.90 minutes) and was statistically significant (p=0.035). Time for two segment regression, time for complete sensory regression(s1) and total duration of analgesia were longest in group 10 (120 ± 21.21minutes, 204.50 ±32.35 minutes, 218.50 ±34.94 minutes respectively) as compared to group 15 (99.00 ± 17.43 minutes, 181.50 ±19.43 minutes, 209.00 ±18.02 minutes respectively) which was longer than group 0 (79 ± 14.81 minutes, 116.50 ± 22.17 minutes, 125.50 ± 24.11 minutes respectively).The parameters were statistically significant (p=0.000) among the groups. No statistically significant difference among the groups were observed with respect to time of onset of motor block and maximum motor blockade. The total duration of motor blockade was longer in group 10 (193.00 ± 32.65 minutes) as compared to group 15 (162.00 ± 15.45 minutes) and group 0 (106.00 ± 18.02 minutes). Hemodynamic stability was better in group 0 and group 10 when compared to group 15. Conc...

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“…Recently, this has been modified to intrathecal administration of a small dose of the local anesthetic with opioid followed immediately by epidural administration of saline (epidural volume extension) or local anesthetic (low-dose sequential CSE). [ 9 ] This modified technique had been successfully used for cesarean section in high-risk parturients with various forms of congenital and acquired cardiac diseases,[ 10 11 ] but has never been reported in CC-TGA. Regarding other neuraxial techniques, single shot spinal anesthesia produces significant hemodynamic compromise requiring rapid fluid loading and high-dose vasopressor administration which are unacceptable in high-risk cardiac patients,[ 10 ] while continuous spinal anesthesia (incremental injection through an indwelling intrathecal catheter) is associated with increased risk of postdural puncture headache.…”

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confidence: 99%