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Sensory block extension during combined spinal and epidural
C Mardirosoff1, L Dumont, P Lemédioni
1Department of Anesthesiology, Brugmann University Hospital, Brussels, Belgium.
Regional Anesthesia and Pain Medicine
|April 29, 1998
Summary
The volume effect of epidural saline after spinal anesthesia is time-dependent, enhancing sensory block when given soon after spinal injection. This effect diminishes if patients remain seated for five minutes post-injection.
Area of Science:
- Anesthesiology
- Neurosurgery
- Pain Management
Background:
- Combined spinal-epidural anesthesia (CSE) is a common technique.
- Epidural injections post-spinal anesthesia can extend sensory block.
- This extension is attributed to volume or local anesthetic effects.
Purpose of the Study:
- To evaluate the time dependency of volume and local anesthetic effects on spinal block extension in CSE.
- To differentiate between the volume effect and local anesthetic effect in CSE.
Main Methods:
- Two prospective studies were conducted with 30 patients each.
- Patients received intrathecal hyperbaric bupivacaine followed by epidural saline or bupivacaine at different time points.
- Sensory block levels were assessed by loss of sensation to cold.
Main Results:
- In the first study, epidural saline given 5 minutes after spinal injection significantly increased sensory block levels compared to 20 minutes or no injection.
- In the second study, no significant differences in sensory block levels were observed between saline, bupivacaine, or no epidural injection when performed 7 minutes after spinal.
- These findings suggest the volume effect is time-dependent.
Conclusions:
- The volume effect of epidural saline in CSE is time-dependent, observed when administered shortly after spinal injection.
- This volume effect is abolished if patients remain seated for 5 minutes post-spinal injection.
- Local anesthetic effects were not demonstrated when high spinal block levels were already achieved.