Reversal of Bupivacaine Epidural Anesthesia by Intermittent Epidural Injections of Crystalloid Solutions

Abstract

This study was designed to determine whether epidural motor blockade could be reversed by postoperative injections of crystalloid solutions via the epidural catheter. Twenty-seven patients (ASA physical status I, nonlaboring) had epidural anesthesia with 0.75% bupivacaine for elective cesarean delivery. Postoperatively, patients were randomized to receive three 15-mL injections (over 30 min) of crystalloid solutions (normal saline or Ringer's lactate) or no treatment (control) via the epidural catheter. Degree of motor and sensory blockade was evaluated with an investigator blinded to treatment group. Rate of resolution of sensory blockade was not different among groups. However, time for resolution of motor blockade was more than twice as long in the control group than in either treatment group (control = 178 +/- 70 min vs Ringer's lactate = 84 +/- 44 min, normal saline = 70 +/- 38 min, P = 0.001). The data suggest that unwanted motor blockade due to epidural anesthesia can be reversed by epidural injections of crystalloid solutions.

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

“…So we use sodium bicarbonate to increase the concentration of nonionized free base and more rapid diffusion rate of the drug to adjacent tissues, including blood and resulting in high peak levels [19]. Our study agrees with the study of Johnson et al [16] that reported injection of 45 mL epidural bolus to each of the treatment groups (normal saline or lactated ringer's solution) but did so in 15 mL aliquots separated by 15 minutes. They found that the 45 mL bolus hastened the resolution of motor but not sensory blockade after 0.75% bupivacaine for cesarean delivery.…”

“…In addition, there is a faster offset in groups A, B, and group C. The mechanism by which epidural injections of crystalloid solutions can alter the neural blockade is unclear. Intensity of epidural blockade may lessen because crystalloid solutions dilute local anesthetics in or adjacent to the epidural space, decreasing the concentration of unbound drug at neuronal sites of action [16].…”

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

“…In addition, progressive changes of the spinal column associated with aging have been postulated to produce a narrowing of the intervertebral foramina along the column. This was why we used a smaller volume (30 ml) of saline in our elderly patients than others (40–45 ml) [3–5].…”

“…Redistribution can be enhanced by decreasing the concentration of residual local anaesthetics in the epidural space. Washout of the epidural space with 20–45 ml of saline has been proposed to accelerate recovery from epidural block with contradictory results in clinical studies [1–6]. Most of the previous studies of epidural washout have shown beneficial effects on recovery, particularly in the ambulatory surgical settings.…”

<p>Advantages of the Combination of Conscious Sedation Epidural Anesthesia Under Fluoroscopy Guidance in Lumbar Spine Surgery</p>

“…Surprisingly, this includes patients undergoing fusions, with the significant muscle dissection and manipulation needed there, and even to endoscopic epidural procedures, where constant flow of irrigation threatens to wash away all anesthetic from the epidural space. [24][25][26][27] In cases of revision surgery where there are significant epidural adhesions inhibiting the spread of anesthetic adequately, adding new analgesic method such as thoracolumbar interfascial plane block (TLIP), modified TLIP and Erector spinae plane block (ESP) 28-30 together with epidural anesthesia will give us more complete and satisfied results of anesthesia and analgesia.…”