The extension of combined spinal-epidural anaesthesia with a low dose of local anaesthetics and opioid using epidural “top-up”

Marinela Haţegan¹, Iurie Acalovschi², Ioana Kovacs¹
1. Spital Judeţean Deva - Secţia ATI. 2. Catedra ATI a UMF “Iuliu Haţieganu” Cluj-Napoca

Abstract

Introduction. Epidural injection of saline in combined spinal-epidural (CSE) anesthesia results in the extension of the maximal level of sensory blockade. This may facilitate the subarachnoid use of a low dose of local anaesthetics. The purpose of our study was to investigate the comparative efficacy of low dose spinal bupivacaine and ropivacaine plus fentanyl in CSA anaesthesia and epidural “top-up” with saline.

Method. Thirty patients scheduled for lower limb orthopedic surgery under combined spinal-epidural anesthesia, were randomly allocated into two equal groups: group BF which received a subarachnoid injection of 8 mg bupivacaine 0.5% + 10 µg fentanyl and group RF which received a subarachnoid injection of 12 mg ropivacaine 1% + 10µg fentanyl. After 4 minutes the maximal level of sensory blockade was assessed and an epidural “top-up” was given with 1-2 boluses of 5 ml saline. The increase and then the regression of the sensory block were determined. The degree of the motor block according to the Bromage scale, the hemodynamic changes and the incidence of the adverse effects were also assessed.

Results. The subarachnoid administration of the local anaesthetic developed a sensory block at T9-T10 in both groups. Epidural top-up with saline determined the extension of the sensitive block with 4-5 segments and the onset of the Bromage III motor block in all patients with no differences between the groups. The regression of the sensitive block was significantly faster in group BF and with regard to the motor block, significantly faster in group RF. There were no side effects in both groups.

Conclusions. In combined spinal-epidural anaesthesia an epidural “top-up” with saline increased the subarachnoid block produced by low doses of bupivacaine and ropivacaine associated with fentanyl. The increase of the sensory block was not influenced by the nature of the local anaesthetic

Key words: combined spinal-epidural anaesthesia (CSE), low dose of local anaesthetic, epidural “top-up”, bupivacaine, ropivacaine.

Utilizarea tehnicii combinate spinal-epidurale cu doze reduse de anestezic local şi opioid prin mecanism de extensie prin volum epidural

Jurnalul Român de Anestezie Terapie intensivă 2004 Vol.11 Nr.1, 26-32