“EFFECT OF EPIDURAL VOLUME ON SPINALANAESTHESIA IN PATIENTS UNDERGOING GYNAECOLOGICAL SURGERY”

Abstract

BACKGROUND: The epidural volume extension (EVE) technique is a modication of Combined Spinal Epidural Anesthesia (CSEA) in which the level of sensory analgesia obtained via subarachnoid block (SAB) is increased by a small volume of saline or local anaesthetic (LA) administered into epidural space through the epidural catheter. OBJECTIVE OFTHE STUDY: To study the effect of epidural volume on the time of onset of sensory blockade and the maximum height of the sensory block achieved in spinal anesthesia. MATERIALS AND METHODS: A prospective randomized study of 100 patients belonging to ASA physical status I & II. A pre-anesthetic evaluation and clinical examination with baseline investigations like CBC, urine routine, CXR, blood sugars, RFTand ECG were done. Patients were randomly allocated into 2 groups of 50 each. Group S(control) received 3 ml of 0.5% Bupivacaine (H) injection intrathecally. Group E(study) received 10 ml of Normal Saline epidurally immediately after spinal anesthesia with 3 ml of 0.5% Bupivacaine (H). The time of Onset of sensory blockade, maximum height of sensory block, hemodynamic status and adverse effects if any were compared in both the groups. RESULTS: The time of onset of sensory block was signicantly lower in Group E (2.08 ±0.77) than Group S (3.22±0.84). The maximum height of sensory block attained by Group E was T1 (18%) while that in Group S was T2 (6%). Maximum no of patients (36%) in group E attained a sensory level of T2 whereas in Group S, maximum no. of patients (40%) attained a sensory height of T6. Hemodynamic changes were not much different in patients of both the groups. The side effect was less in Group S as compared to Group E. CONCLUSION: We concluded that EVE of 10 ml of 0.9% saline with 3 ml of intrathecal 0.5% bupivacaine(H) fastens the onset and increases the height of sensory block with minimal hemodynamic changes.