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

Abstract

We concluded that a more rapid recovery of motor and sensory blockade in patients undergoing epidural anesthesia may be achieved by the use of an epidural washout with either bolus or infusion of 45 mL normal saline or Ringer's lactate.

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

“…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.…”

“…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].…”

“…Testing was performed by moving in the cranial direction and the level of the highest dermatome where the sensation was perceived as not painful or cold was recorded. Motor blockade was assessed using a modified Bromage scale (M 1 , inability to move the toes, knees, or hips; M 2 , ability to dorsal flex the foot; M 3 , ability to flex the knee; M 4 , hip flexion (less than 10 s); M 5 , hip flexion (more than 10 s); and M 6 , no motor blockade) [5]. During anaesthesia and surgery, hypotension (systolic blood pressure less than 90 mmHg or more than a 20% decrease from baseline) was treated with fluid infusion and repeated doses of ephedrine 4 mg.…”

“…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.…”

Reversal of Bupivacaine 0.5% Epidural Anesthesia Using Epidural Saline Washout

“…[3] Rapid recovery of motor and sensory block in outpatient patients undergoing 2% prilocaine epidural anesthesia may be achieved by an epidural washout with either bolus or infusion of 45 mL NS or RL. [4] Thus, studies have shown benefits of epidural washout with crystalloid boluses or infusion, but the effectiveness of bolus of NS in nonobstetrical patients undergoing 0.5% bupivacaine epidural anesthesia has not been investigated. We designed this study to determine the relationship of the epidural NS bolus to the recovery of motor and sensory block and hemodynamic stability (blood pressure and heart rate) in nonobstetrical patients undergoing epidural anesthesia using 0.5% bupivacaine.…”