Epidural volume extension with saline in combined spinal epidural anesthesia for dynamic hip screw surgeries using low dose of intrathecal hyperbaric bupivacaine

Abstract

Background Combined spinal epidural (CSE) anesthesia is the preferred and widely used method for lower limb orthopedic surgeries. The epidural volume extension (EVE) technique is a modification of CSE in which the level of sensory analgesia obtained by subarachnoid block is increased by a small volume of saline administered through the epidural catheter. Patients and methods Fifty patients of both sexes, aged between 50 and 70 years scheduled for dynamic hip screw surgery were enrolled in the study. Patients were divided into two groups: group I (the CSE-EVE group) included 25 patients who were anesthetized using CSE with EVE and group II (the CSE group) included patients who were anesthetized using CSE without EVE, using the same technique and the same dose of intrathecal hyperbaric bupivacaine and fentanyl. Results Regarding all demographic data (age, height, weight, sex, and duration of operation), there were no statistically significant differences between the studied groups ( P = 0.248, 0.901, 0.064, 0.564, and 0.967, respectively). Regarding the block profile, there was a statistically significant difference between the two groups regarding the level of maximal sensory block ( P P P P P Conclusion It can be concluded that low dose of intrathecal hyperbaric bupivacaine with EVE (10 ml saline) is associated with early onset of motor and sensory block, high level of sensory block, and shorter time of two-segment regression while maintaining hemodynamic stability.