J Korean Pain Soc.  2000 Jun;13(1):84-88.

Effects of Saline and Bupivacaine for Epidural Top-up on Sensory Blockade Level during Combined Spinal Epidural Anesthesia

• Kim DY
• Han JI

Abstract

BACKGROUND: An increase in the maximum level of sensory blockade (MLSB) following an epidural top-up in combined spinal epidural anesthesia (CSE) may be achieved by a volume effect as the volume of local anesthetic compresses the dural sac, by a local anesthetic effect, or by a combination of both effects. This study was conducted to investigate the contribution of each of these effects.
METHODS
Sixty patients scheduled for lower limb surgery under CSE were randomly allocated to one of three groups of twenty patients each. Using the needle-through needle technique, all patients received a subarachnoid dose of 10 mg hyperbaric 0.5% bupivacaine. At 30 min after subarachnoid injection, an epidural top-up with saline 10 ml (group II) or 0.5% bupivacaine 10 ml (group III was administered; patients in group I received no epidural top-up. The level of sensory blockade was assessed at 5, 10, 15, 20, 25, 30 min after subarachnoid injection and at 5, 10, 15, 20, 25, 30 min after epidural top-up.
RESULTS
There was no significant difference in the MLSB and the onset time of MLSB among group I-III.
CONCLUSIONS
We concluded that the epidural top-up with saline 10 ml or 0.5% bupivacaine 10 ml which injected at 30 min after subarachnoid injection did not significantly increase the level of subarachnoid block in lower extremity surgical patients.

Keyword

Anesthesia, spinal, sensory blockade; Anesthetic techniques, combined spinal epidural

MeSH Terms

Anesthesia, Epidural*
Anesthetics
Bupivacaine*
Humans
Lower Extremity
Needles
Anesthetics
Bupivacaine