Combined Spinal-Epidural Anesthesia Using Epidural Volume Extension for Elective Cesarean Delivery / 대한마취과학회지

ABSTRACT

BACKGROUND: Epidural volume extension (EVE) via a combined spinal-epidural (CSE) technique involved the enhancement of a small-dose intrathecal block using epidural saline boluses. We compared the EVE technique and single-shot spinal anesthesia with respect to sensory and motor block profiles and hemodynamic stabilities. METHODS: Seventy parturients undergoing elective cesarean deliveries were administered either spinal anesthesia with hyperbaric 0.5% bupivacine 10 mg plus fentanyl 15microgram or CSE anesthesia (comprising intrathecal hyperbaric 0.5% bupivacine 7 mg with fentanyl 15microgram followed by 0.9% saline (5.0 ml)) through a Tuohy needle. In each group, the lowest systolic blood pressure, sensory block level and peak sensory block height to loss of cold sensation to ice were recorded at 1 min intervals. Modified Bromage motor scores and time for sensory regression to the tenth thoracic dermatome (T10) were compared between groups in the PACU. RESULTS: Patients in the CSEA group demonstrated significantly faster motor recovery to modified Bromage 0 (82.2 +/-18.7 min versus 121.1 +/- 15.2 min respectively, P <0.05). CONCLUSION: Our study shows that CSE with EVE provides adequate anesthesia for elective cesarean delivery at only 70% of the bupivacine dose and allows a more rapid motor recovery of the lower limbs, which may have a beneficial impact on PACU stay.