The influence of epidural volume expansion on spinal block with hyperbaric bupivacaine for elective knee arthroplasty
Ertaç Özeroğlu1, Fulya Yılmaz2
1Ardahan Devlet Hastanesi, Kars
2Sağlık Bilimleri Üniversitesi Bozyaka Eğitim ve Araştırma Hastanesi Anesteziyoloji ve Reanimasyon Kliniği, İzmir
BACKGROUND AND AIM: 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. The aim of this study was to evaluate the sensory and motor block characteristics of epidural volume extension with 10 ml epidural saline after 10 mg intrathecal hyperbaric 0.5 % bupivacaine.
METHODS: This prospective, randomized, double-blind study was conducted in a operation room setting of a university hospital. After hospital Ethics Committee approval and written informed consent, 80 patients were allocated randomly, into two groups (n=40). Using the combined spinal-epidural technique, Group 1 received 10 mg of spinal hyperbaric 0.5% Bupivacaine and Group 10 mg of spinal hyperbaric 0.5% Bupivacaine subsequently followed by 10 ml of Normal Saline through the epidural catheter. An anaesthetist blinded to theanaesthetic solution injected examined the level of analgesia by the pinprick method and motor block with the modified Bromage scale 3 minutes interval for 30 min after subarachnoid injection, during the intraoperative period and subsequently every 15 min during the recovery period.
RESULTS: RESULTS: Time to reach adequate block (Sensorial block T10 and Bromage score 2-3) was significantly shorter in Group 2 and than in Group 1. During the intraoperative period, sensory block levels were significantly higher in Group 2 than in Group 1. Peak sensorial level was significantly higher in Group 2 than Group 1. Sensoryal block regression to T10 level was significantly longer in Group 2 than Group 1. The motor score was significantly lower at 3th, 6th and 9th minutes in Group 1 than Group 2.
CONCLUSIONS: This study demonstrates a benefit in using epidural volume extension with 10 ml saline, as a part of a combined spinal epidural technique by providing earlier adequate block, higher sensorial block and longer motor block during the operation period in total knee artroplasty.
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