| The Effects of Epidural "Top-up" on Spinal Block during Combined Spinal Epidural Anesthesia for Cesarean Section. |
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Duck Hwan Choi, Nam Kee Park, Jie Ae Kim, Woo Seog Sim |
1Department of Anesthesiology, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Korea.
2Department of Anesthesiology, Sejong General Hospital, Puchon, Korea. |
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| 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. |
| Key Words:
Anesthetics, local: bupivacaine; Anesthetic technique: combined spinal-epidural; spinal; Surgery, obstetrics: cesarean section |
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