Korean J Anesthesiol.  2000 Jan;38(1):69-75. 10.4097/kjae.2000.38.1.69.

The Effects of Epidural "Top-up" on Spinal Block during Combined Spinal Epidural Anesthesia for Cesarean Section

• Choi DH
• Park NK
• Kim JA
• Sim WS

• KMID: 2091491
• DOI: http://doi.org/10.4097/kjae.2000.38.1.69

Abstract

BACKGROUND: Epidural "top-up" has been known to enhance spinal anesthesia in combined spinal-epidural anesthesia. Saline and local anesthetics were reported to have a volume effect when infused as epidural "top-up". In cesarean deliveries where high sensory block has been achieved using a combined spinal-epidural technique, we evaluated the effects of epidural "top-up" on the underlying spinal block.
METHODS
Sixty-six parturients were allocated randomly into group C (control, n = 21), S (saline, n = 21), or B (bupivacaine, n = 24). Ten minutes after they received 8 mg of 0.5% hyperbaric bupivacaine intrathecally, nothing, 10 ml saline, or 10 ml of 0.25% bupivacaine were infused, respectively. The sensory level at 10 min, the maximal level and the time to reach it, and degrees of motor block and muscle relaxation were compared. We also investigated intraoperative side effects and postoperative findings in the PACU.
RESULTS
There were significant changes in sensory level after epidural top-ups in the group S and B, but no differences in maximal height of sensory block and degree of muscle relaxation among the groups. Intraoperative pain was complained in fewer patients in the group B. Times to sensory and motor recovery were longer in patients of the group B.
CONCLUSIONS
Eight milligrams of hyperbaric bupivacaine using a combined spinal-epidural technique was not sufficient for cesarean section. Epidural saline top-up showed volume effect, which didn't improve the spinal block. Epidural "top-up" of 0.25% 10 ml bupivacaine enhanced the spinal block and sustained the block postoperatively.

Keyword

Anesthetics, local: bupivacaine; Anesthetic technique: combined spinal-epidural; spinal; Surgery, obstetrics: cesarean section

MeSH Terms

Anesthesia
Anesthesia, Epidural*
Anesthesia, Spinal
Anesthetics, Local
Bupivacaine
Cesarean Section*
Female
Humans
Muscle Relaxation
Pregnancy
Anesthetics, Local
Bupivacaine