Comparison of adverse effects of epidural volume extension with different volumes of normal saline

Abstract

Epidural volume extension (EVE) refers to an injection of normal saline through epidural catheter following an intrathecal block. It results in a rapid increase in the sensory level of subarachnoid block. Thus, it has been postulated that EVE may be used as a rescue strategy for an inadequate post-spinal sensory block. Women were randomly distributed into three equal groups: Group A(CSE with no EVE), Group B(CSE followed by EVE using 5ml of normal saline) and Group C (CSE followed by EVE using 7.5ml of normal saline). All group received a fixed dose 7.5mg of 0.5% levo- bupivacaine with 25µg of fentanyl followed by epidural volume extension with 5ml of saline in Group B and 7.5ml of saline in Group C in the epidural space. Epidural space is identified (L3-L4) with 18G Tuohy needle & dural puncture performed using a 25G spinal needle and study drug injected; epidural catheter is inserted 3cm into the epidural space and five minutes after insertion of the epidural catheter, normal saline is administered through it for EVE. Epidural volume extension (5 ml/7.5 ml NS) after intrathecal levobupivacaine (7.5mg)-fentanyl can provide desired level of block for CS when compared to intrathecal levobupivacaine (7.5mg)-fentanyl alone, with no significant side effects.