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The influence of epidural volume extension on spinal block with hyperbaric or plain bupivacaine for Caesarean delivery

Published online by Cambridge University Press:  01 April 2008

S. Kucukguclu ,
H. Unlugenc ,
F. Gunenc ,
B. Kuvaki ,
N. Gokmen ,
S. Gunasti ,
S. Guclu ,
F. Yilmaz  and
G. Isik
S. Kucukguclu
Affiliation:
Dokuz Eylül University, School of Medicine, Department of Anesthesiology and Reanimation, İzmir, Turkey
H. Unlugenc
Affiliation:
Cukurova University, School of Medicine, Department of Anesthesiology and Reanimation, Adana, Turkey
F. Gunenc
Affiliation:
Dokuz Eylül University, School of Medicine, Department of Anesthesiology and Reanimation, İzmir, Turkey
B. Kuvaki
Affiliation:
Dokuz Eylül University, School of Medicine, Department of Anesthesiology and Reanimation, İzmir, Turkey
N. Gokmen*
Affiliation:
Dokuz Eylül University, School of Medicine, Department of Anesthesiology and Reanimation, İzmir, Turkey
S. Gunasti
Affiliation:
Cukurova University, School of Medicine, Department of Anesthesiology and Reanimation, Adana, Turkey
S. Guclu
Affiliation:
Dokuz Eylül University, School of Medicine, Department of Obstetrics and Gynecology, İzmir, Turkey
F. Yilmaz
Affiliation:
Dokuz Eylül University, School of Medicine, Department of Anesthesiology and Reanimation, İzmir, Turkey
G. Isik
Affiliation:
Cukurova University, School of Medicine, Department of Anesthesiology and Reanimation, Adana, Turkey
*
Correspondence to: Necati Gokmen, Dokuz Eylül Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon AD, 35340 Inciralti, Izmir, Turkiye. E-mail: necati.gokmen@deu.edu.tr; Tel: +90 232 4122810; Fax: +90 232 4122810
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Summary

Background and objective

Epidural volume extension via a combined spinal–epidural is the enhancement of a small-dose intrathecal block by an epidural injection of physiological saline solution. We evaluated the effect of epidural volume extension on the combined spinal–epidural technique of providing spinal anaesthesia for Caesarean section with hyperbaric or plain 0.5% bupivacaine.

Methods

Patients (n = 240) with height >163 cm received 9 mg and patients <163 cm received 8 mg of bupivacaine. Each study drug was combined with 20 μg fentanyl. Using the combined spinal–epidural technique, Group A (n = 60) received hyperbaric bupivacaine, and Group B (n = 60) received hyperbaric bupivacaine and 10 mL saline epidurally 5 min after subarachnoid injection. Group C (n = 60) received plain bupivacaine and Group D (n = 60) received plain bupivacaine and 10 mL saline epidurally 5 min after subarachnoid injection. An anaesthetist blinded to the anaesthetic solution injected examined the level of analgesia by the pinprick method and motor block with the modified Bromage scale for 30 min after subarachnoid injection, during the intraoperative period and subsequently every 15 min for 135 min during the recovery period.

Results

Time to reach a sensory block at T4 was significantly shorter in Groups C and D than in Groups A (P = 0.003 and 0.017) and B (P = 0.006 and 0.048), respectively. During the intraoperative period, sensory block levels were significantly higher in Group C than in Group A. Recovery was similar in all groups; only onset was faster in Groups C and D.

Conclusion

There was no effect of epidural volume extension on the profile of spinal anaesthesia with the combined spinal–epidural technique for Caesarean section using hyperbaric or plain bupivacaine.

Keywords

ANAESTHESIA SPINALANAESTHESIA EPIDURALBUPIVACAINEEPIDURAL SPACE, volume expansionCAESAREAN SECTION.
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 4 , April 2008 , pp. 307 - 313
Copyright
Copyright © European Society of Anaesthesiology 2007

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