Related Experiment Video
Updated: May 11, 2026

Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia
Published on: January 31, 2025
Combined spinal-epidural anesthesia with epidural volume extension causes a higher level of block than single-shot
Canan Salman1, Nurten Kayacan, Fatma Ertuğrul
1Medical Park Hospital, Department of Anesthesiology and Reanimation, Antalya, Turkey.
Background And Objectives:
We evaluated the effects of epidural injection with levobupivacaine or serum physiologic, epidural volume extension (EVE), when using combined spinal-epidural anesthesia (CSEA) for cesarean delivery.
Methods:
One-hundred and thirty-eight patients with a full-term pregnancy of 37-42 weeks that were scheduled for cesarean delivery were included. Group 1 (n=48) received single-shot spinal anesthesia (SSS), group 2 (n=45) received CSEA-EVE with saline, group 3 received CSEA-EVE with levobupivacaine. The characteristics of motor and sensory block, the effects on maternal hemodynamic changes and the effects on the newborn were compared.
Results:
Time to reach maximum sensory block was significantly shorter in groups 3 than in group 1 and 2 (p<0.05). Two-segment regression time of sensory block was significantly shorter in group 1, whereas it was significantly longer in group 3 than in group 2 (p<0.05). Time to onset of motor block was significantly longer in group 1 than in groups 2 and 3 (p<0.05). Time to reach maximum motor block was significantly shorter in group 3 than in groups 1 and 2 (p<0.05). Time to recovery of motor block was significantly longer in group 3 than in groups 1 and 2 (p<0.05). The time to first analgesic was significantly longer in group 3 (p<0.05).
Conclusions:
Sufficient and rapid motor and sensory block was achieved in all the patients in the present study; however, motor and sensory block had faster onset, lasted longer, and was of a higher level in groups 2 and 3; these effects were more pronounced in the group 3.
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