Reversal of Bupivacaine Epidural Anesthesia by Intermittent Epidural Injections of Crystalloid Solutions

Abstract

Local anesthetic-induced neuroblockade can be reversed rapidly by washing isolated nerve preparations with crystalloid solutions. To assess if similar results were clinically feasible, the authors studied 26 women undergoing elective non-laboring cesarean section under epidural anesthesia produced by 0.75% bupivacaine. A blinded investigator measured the level of sensory anesthesia and the degree of motor blockade using the Bromage scale. Levels were recorded before incision, at the end of surgery, and then every 15 minutes during recovery. Patients were randomly assigned to one of three groups, on the basis of receiving, over 30 minutes after the end of surgery via the epidural catheter, no injection, three 15-ml injections of Ringer's lactate or normal saline. 20 patients had plasma bupivacaine levels determined at the end of surgery and 45 minutes later.