Reversal of Lidocaine with Epinephrine Epidural Anesthesia Using Epidural Saline Washout

Sitzman, Todd B.; DiFazio, Cosmo A.; Playfair, Paul A.; Stevens, Rosemary; Hanes, Chad F.; Herman, Todd B.; Yates, Kendall H.; Leisure, George S.

doi:10.1097/00115550-200106000-00008

Cited by 4 publications

(7 citation statements)

References 14 publications

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“…Regression of motor block after epidural washout was twice as fast as in the control group (17 vs 32 min). Motor recovery showed similar results to those of previous studies using local anaesthetic solution with or without adrenaline [1, 4–6]; however, the influence of epidural washout on the speed of sensory regression was less than on motor regression. This discrepancy between speeds of sensory and motor regression may be attributed to the diluting effect of epidural saline.…”

Section: Discussionsupporting

confidence: 85%

“…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.…”

mentioning

confidence: 99%

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

Park¹,

Kil

Park³

et al. 2009

Anaesthesia

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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.

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Section: Discussionsupporting

confidence: 85%

mentioning

confidence: 99%

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

Park¹,

Kil

Park³

et al. 2009

Anaesthesia

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“…We add sodium bicarbonate with normal saline because normal saline 0.9% is slightly acidic at a PH of 5.0 and we could lower the PH of bupivacaine which would result in less redistribution from epidural space. 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.…”

Section: Discussionsupporting

confidence: 88%

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

Attia

Mohamed

Bader

2015

Advances in Anesthesiology

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Background. Orthopedic procedures are among the commonest surgeries in the elderly. On the other hand, those patients have many risk factors suitable for development of postoperative complication due to prolonged postoperative recumbent that decrease by using anesthesia technique allowed early ambulation as far as possible. Aim of the Work. The aim of this study was to evaluate whether washout of the local anesthesia with 0.9% normal saline with bicarbonate through the epidural catheter could provide early ambulation throughout the faster recovery of the motor block. Patient and Methods. Sixty adult patients were included in this study and divided into three groups. In group I, epidural injection of bupivacaine was carried out without wash (control group). In group II, epidural injection of bupivacaine was followed by wash. In group III, epidural injection of both bupivacaine and nalbuphine was followed by wash. Results. They were significantly faster in both group II and group III as compared with group I. In group I, sensory recovery was insignificantly faster than the motor recovery. In group II motor recovery was significantly faster than sensory recovery. In group III motor recovery was significantly faster than the sensory recovery. Conclusions. These results suggested that early ambulation with an adequate postoperative analgesia was reported in patient receiving epidural injection of both bupivacaine and nalbuphine.

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“…Because the surgical procedures in this study were relatively short, no cases of premature epidural regression was seen after epidural washout. Sitzman et al 8 compared 0, 15, and 30 mL of normal saline washout after 2% lidocaine with epinephrine epidural anesthesia. They demonstrated that times to partial and full recovery from motor and sensory block were significantly faster with epidural washout with 30 mL NS.…”

Section: Discussionmentioning

confidence: 99%

“…So, we preferred an intermediate duration local anesthetic (2% prilocaine) as in the previous study. 8 We administered the same volumes by infusion or intermittent bolus injection of NS or RL. We expected that infusion may be an alternative method to repeated boluses to reverse epidural blockade.…”

Section: Discussionmentioning

confidence: 99%

Reversal of Prilocaine Epidural Anesthesia Using Epidural Saline or Ringer’s Lactate Washout

Katırcıoğlu

Özkalkanlı

Kalfaoglu

et al. 2007

Regional Anesthesia and Pain Medicine

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Reversal of Lidocaine with Epinephrine Epidural Anesthesia Using Epidural Saline Washout

Cited by 4 publications

References 14 publications

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

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

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

Reversal of Prilocaine Epidural Anesthesia Using Epidural Saline or Ringer’s Lactate Washout

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