randomized trial of epidural volume extension by sequential combined spinal epidural anesthesia using three different techniques

ABSTRACT

Sequential combined spinal epidural anesthesia [SCSEA] is gaining popularity in ASA grade III / IV, elderly, low cardiac output state and high risk patients. In view of contradicting results related to sensorimotor characteristics, we undertook this study with the null hypothesis that epidural volume extension [EVE] with local anesthetic or normal saline results in augmentation of initial intrathecal block. Prospective, randomized, double blind study. J N Medical College, Aligarh Muslim University, Aligarh, India. Seventy-five ASA I/II patients divided into three groups and operated upon from September 2007 to January 2009. Group I received 1.5 ml bupivacaine [0.5%] + 25 microg fentanyl in subarachnoid space and epidural catheter was inserted without any top ups. In group II and III with the same technique top ups were given after 10 minutes of the intrathecal block in the form of either 10 ml NS or 10 ml of 0.125% bupivacaine. Augmentation of initial intrathecal block. Significant increase in height of block was seen after EVE by different techniques of epidural top up [T4.64 +/- 0.86 and T3.92 +/- 0.99 in group II and III respectively, p-value < 0.05] as compared to group I [T7.12 +/- 0.83]. The average increase was 3.12 +/- 0.97 and 3.48 +/- 1.35 segments in group II and III respectively as compared to 0.48 +/- 0.51 segments in group I.. Height of low-dose intrathecal block can be enhanced by SCSE using EVE effect even with normal saline