Korean J Anesthesiol.  2005 Aug;49(2):188-192. 10.4097/kjae.2005.49.2.188.

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

• Kim AR
• Oh KH

• KMID: 2092029
• DOI: http://doi.org/10.4097/kjae.2005.49.2.188

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.

Keyword

bupivacaine; cesarean delivery; spinal anesthesia; combined spinal-epidural anesthesia

MeSH Terms

Anesthesia*
Anesthesia, Spinal
Blood Pressure
Bupivacaine
Fentanyl
Hemodynamics
Humans
Ice
Lower Extremity
Needles
Sensation
Bupivacaine
Fentanyl
Ice