Authors : Shobhit Singh, Shobhit Singh, B C Vijayalakshmi, B C Vijayalakshmi, Deepa Kattishettar, Deepa Kattishettar
DOI : 10.18231/j.ijca.2019.042
Volume : 6
Issue : 2
Year : 2019
Page No : 224-228
Introduction: The technique of combined spinal epidural (CSE) anaesthesia has become popular for patients undergoing elective infraumbilical surgeries where intraoperative prolonged and effective post-operative analgesia is required. CSE has the reliability of subarachnoid block as well as the flexibility of epidural block. The epidural volume expansion (EVE) technique is a modification of CSE in which the level of sensory analgesia obtained by subarachnoid block is increased by saline administered through the epidural catheter.
Aims and Objectives: The present study was designed to compare different volumes of normal saline (10ml and 15ml) for epidural volume expansion on spinal anaesthesia with 10 mg (2 ml) of 0.5% hyperbaric bupivacaine for elective infraumbilical surgeries in adult patients with respect to sensory and motor block characteristics and haemodynamic stability.
Materials and Methods: In this randomized, double blind, prospective study, ninety patients of ASA I and II of age group 18 – 59 years undergoing elective infraumbilical surgeries were randomly assigned into three groups namely group 0, group 10 and group 15. Combined Spinal Epidural technique was performed using double segment technique in lateral position in all the patients. Group 0 received 10 mg of 0.5% hyperbaric Bupivacaine intrathecally without EVE, group 10 received 10mg of 0.5% hyperbaric Bupivacaine followed by EVE with 10 ml of normal saline, group 15 received 10mg of 0.5% hyperbaric Bupivacaine followed by EVE with 15 ml of normal saline.
Results: There were no statistically significant difference in the demographic data among the studied groups. Regarding block profile, the time of onset of sensory block was found to be statistically insignificant whereas a significant difference was noted among the three groups regarding maximum level of sensory blockade. Time to achieve maximum level of sensory blockade was observed to be longest in group 15 (mean ± SD: 4.76 ±0.72 minutes) as compared to group 10 (mean ± SD: 4.60 ± 0.56 minutes) which was longer when compared to group 0 (4.26 ± 0.90 minutes) and was statistically significant (p=0.035). Time for two segment regression, time for complete sensory regression(s1) and total duration of analgesia were longest in group 10 (120 ± 21.21minutes, 204.50 ±32.35 minutes, 218.50 ±34.94 minutes respectively) as compared to group 15 (99.00 ± 17.43 minutes, 181.50 ±19.43 minutes, 209.00 ±18.02 minutes respectively) which was longer than group 0 (79 ± 14.81 minutes, 116.50 ± 22.17 minutes, 125.50 ± 24.11 minutes respectively).The parameters were statistically significant (p=0.000) among the groups. No statistically significant difference among the groups were observed with respect to time of onset of motor block and maximum motor blockade. The total duration of motor blockade was longer in group 10 (193.00 ± 32.65 minutes) as compared to group 15 (162.00 ± 15.45 minutes) and group 0 (106.00 ± 18.02 minutes). Hemodynamic stability was better in group 0 and group 10 when compared to group 15.
Conclusion: Epidural volume expansion (EVE) has definite advantages over subarachnoid block alone. EVE of 10 ml of saline with intrathecal 0.5% Bupivacaine is better when compared to EVE of 15 ml of saline with regard to sensory and motor block characteristics while maintaining the hemodynamic stability.
Keywords: Combined spinal epidural, Epidural volume expansion, Intrathecal bupivacaine.