Mechanism of Action of an Epidural Top-Up in Combined Spinal Epidural Anesthesia

Stienstra, Rudolf; Dahan, Albert; Alhadi, Ban Z. R.; Kleef, Jack W. van; Burm, A. G. L.

doi:10.1213/00000539-199608000-00031

Cited by 79 publications

(51 citation statements)

References 7 publications

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“…Rudolf Steinstra and colleagues 6 , in their study to elucidate the mechanism of action of an epidural top-up in CSEA have found that the maximum level of sensory blockade with 2 ml of 0.5% bupivacaine in the spinal phase varied between T8.1±4.5 to T9.7±2.7 in various groups, with onset times of 15.0±9.1 and 15.5±4.4 respectively, which is comparable with our study. In the epidural phase the maximum sensory level reached in the group who have received 10 ml of bupivacaine through the catheter was T4.9±2.3 with a segmental increase of 4.8±1.6 which is again comparable with our study.…”

Section: Methodssupporting

confidence: 91%

“…Based on this finding, it appears that increase in the maximum level of sensory blockade after an epidural top-up with bupivacaine initially occurs by a volume effect, augmented by a local anaesthetic effect. Rudolf Stienstra and colleagues 6 , in their study have found that the onset time for the saline group was 9.3±4.5 minutes, where as it was 17.0±6.7 minutes for the bupivacaine group. This shows that the sustenance phase was missing in the saline group.…”

Section: Methodsmentioning

confidence: 88%

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Combined Spinal and Epidural Anaesthesia (CSEA) using separate interspace technique

Achar

2012

Sri Lankan J Anaesthesiol

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Section: Methodssupporting

confidence: 91%

Section: Methodsmentioning

confidence: 88%

Combined Spinal and Epidural Anaesthesia (CSEA) using separate interspace technique

Achar

2012

Sri Lankan J Anaesthesiol

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“…Concerning the mechanism of extension of spinal anesthesia by extradural injection of local anesthetic, it is partly a volume effect and partly an effect of local anesthetic itself. 10,11 Thus, extradural saline would extend the sensory block, but less than that by a local anesthetic. An increased spread of 4 to 5 segments is expected over 15 min after a 10 ml bupivacaine 0.5% epidural injection in a combined spinal-epidural anesthesia.…”

Section: Resultsmentioning

confidence: 99%

Onset of spinal block is more rapid with isobaric than hyperbaric bupivacaine

Martin

Frigon

Chretien

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: To compare isobaric with hyperbaric 9.75 mg bupivacaine injected intrathecally, and to evaluate the effects of subsequent injection of lidocaine 2% into the epidural space.Methods: Patients in group 1 (n=30) received isobaric 9.75 mg bupivacaine and in group 2 (n=30) hyperbaric 9.75 mg bupivacaine injected into the subarachnoid space in a combined spinal-epidural technique. They were undergoing urological, gynecological, orthopedic, gastro-intestinal or vascular surgery. Using a double blind technique, the followings parameters were measured: cutaneous analgesia to pinprick, motor blockade, time for two segment regression, time for complete regression of the motor block, quality of anesthesia. In 12 patients the effect of epidural injections of 3 ml lidocaine 2% was observed.Results: Motor and sensory block developed more rapidly (five minutes) in the isobaric group ( P < 0.05) . Maximum upper level (T7 ± 2 ), two-segment regression (52 min in both groups), motor recovery (160 vs 157 min), and quality of anesthesia did not differ between the two groups. Thirty nine epidural injections of 3 ml lidocaine 2% were given in 12 patients 10 min after spinal injection, 28 were in the hyperbaric group (P < 0.05). Twenty six of the epidural injections produced an increase in sensory block of 0 or 1 dermatome, and 13, of 2 or more. Conclusion:The block developed more rapidly in the isobaric group, but both isobaric and hyperbaric 9.75 mg bupivacaine produced adequate upper levels of analgesia for surgery. The effect of epidural injections of 3 ml lidocaine 2% was usually minimal.Objectif : Comparer 9,75 mg de bupivacaïne isobare et hyperbare injectés en sous-arachnoïdien, et évaluer l'effet, quand nécessaire, de la lidocaïne 2 % injectée subséquemment dans l'espace épidural.Méthode : Les patients du groupe 1 (n=30) ont reçu 9,75 mg de bupivacaïne isobare et ceux du groupe 2 (n=30) 9,75 mg de bupivacaïne hyperbare en injection sous-arachnoïdienne selon une technique combinée rachi-épidurale. Des interventions chirurgicales urologiques, gynécologiques, orthopédiques, gastro-intestinales et vasculaires ont été faites. En utilisant une technique de double insu, on a mesuré les paramètres suivants : analgésie cutanée à la piqûre, bloc moteur, temps de régression de 2 niveaux, temps de régression complète du bloc moteur, qualité d'anesthésie. Chez 12 patients qui ont eu besoin d'injections épidurales de 3 ml de lidocaïne 2 %, l'effet de l'injection a été observé.Résultats : Les blocs moteur et sensitif se sont développés plus rapidement (5 min) dans le groupe isobare (P < 0,05). Les niveaux supérieurs d'analgésie (D7 ± 2), les temps de régression de 2 segments (52 min), la récupération motrice (160 vs 157 min), et la qualité de l'anesthésie ont été similaires. Trente-neuf injections épidu-rales de 3 ml de lidocaïne 2 % ont été faites chez 12 patients, 10 min après l'injection sous-arachnoïdienne. Vingthuit des réinjections l'ont été dans le groupe hyperbare (P < 0,05); vingt-six ont produit une augmentation de 0 ou 1 de...

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“…62 In comparisons of postoperative pain control using top-off epidural lidocaine anesthetic or epidural clonidine, epidural saline had a negligible effect on postoperative pain, with clear response to epidural lidocaine or clonidine injection. [63][64][65] Alternatively, when analyzing somatosensory evoked potentials, decrease in amplitude is demonstrated with epidural lignocaine only, but increasing signal latency is demonstrated with both epidural lignocaine and saline, potentially related to a cooling effect. 66 Washout effect can also occur with epidural saline, diluting local inflammatory mediators which either independently act on epidural nociceptors or a contribution to the epidural anesthetic effect.…”

Section: Limitationsmentioning

confidence: 99%

Immediate Pain Response to Interlaminar Lumbar Epidural Steroid Administration: Response Characteristics and Effects of Anesthetic Concentration

Bartynski¹,

Jennings²,

Rothfus³

et al. 2012

AJNR Am J Neuroradiol

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Mechanism of Action of an Epidural Top-Up in Combined Spinal Epidural Anesthesia

Cited by 79 publications

References 7 publications

Combined Spinal and Epidural Anaesthesia (CSEA) using separate interspace technique

Combined Spinal and Epidural Anaesthesia (CSEA) using separate interspace technique

Onset of spinal block is more rapid with isobaric than hyperbaric bupivacaine

Immediate Pain Response to Interlaminar Lumbar Epidural Steroid Administration: Response Characteristics and Effects of Anesthetic Concentration

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