Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.12.005
Brazilian Journal of Anesthesiology
Clinical Research

Clinical utility of epidural volume extension following reduced intrathecal doses: a randomized controlled trial

Asha Tyagi, Mukundan Ramanujam, Ashok Kumar Sethi, Medha Mohta

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Abstract

Background and objectives
Epidural Volume Extension (EVE) involves instillation of normal saline into the epidural space soon after an intrathecal injection, with the aim to augment the sensory block height. Its clinical relevance lies in the possibility of using reduced intrathecal dose and yet achieving the desired sensory block level. Intrathecal dose is a known determinant of the level of sensory block. Whether EVE is dependent on intrathecal dose is not known.

Methods
We conducted a randomized, controlled, double-blind study to compare the maximum sensory level (Smax) achieved with or without application of EVE to two different reduced intrathecal doses. Eighty four adult male patients of ASA status I or II with body weight between 50–70 kg and height in the range of 150–180 cm, scheduled for orthopedic lower limb surgery using combined spinal epidural anesthesia were randomized to receive, either intrathecal dose (5 or 8 mg) with or without EVE, in accordance to group allocation.

Results
Smax was lowered by application of EVE to 5 mg intrathecal bupivacaine (T8.9±4.3 vs. T6.4±1.9 with and without EVE respectively; p = 0.030). Smax was similar when EVE was applied to 8 mg intrathecal bupivacaine than without it (T5.8±1.8 vs. T6.4±2.2 respectively; p =  0.324).

Conclusion
EVE should not be applied to 5 mg plain bupivacaine during a combined spinal epidural block in patients undergoing lower limb orthopedic surgery as it may result in a decrease in the maximum sensory level.

Keywords

Epidural volume extension;  Combined spinal epidural anesthesia;  Orthopedic anesthesia

References

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