Lumbar Epidural Anesthesia Research Articles

Comparison of Lidocaine-Xylazine and Procaine-Xylazine for Lumbar Epidural Anesthesia in Cattle

Lumbar epidural anesthesia is commonly utilized in veterinary medicine for diagnostic, obstetrical, and surgical intervention in the abdominal and perineal regions of large animals. The aim of this study was to directly compare the time to onset and duration of epidural anesthesia produced by lidocaine-xylazine and procaine-xylazine combinations to that produced by xylazine alone in cattle. A total of 24 healthy adult Holstein dairy cows were included in this study. The time to onset and duration of anesthesia were recorded. The heart rate, respiratory rate, and rectal temperature were recorded at 0 minute and at 10, 20, 30, 60, and 90 minutes after the epidural administration of each treatment. The time to onset of anesthesia did not significantly differ between the xylazine only group and the lidocaine-xylazine and procaine-xylazine combination groups. The duration of anesthesia in the xylazine only group was significantly shorter than that in the lidocaine-xylazine and procaine-xylazine combination groups (p < 0.05). Ataxia was not observed in any group. The heart rate, respiratory rate, and rectal temperature values in all the treatment groups throughout the study did not significantly differ from those at baseline. We found that administration of procaine hydrochloride in combination with xylazine hydrochloride, an α2-adrenergic receptor agonist, offers the same time to onset and duration of anesthesia as does epidural anesthesia using a combination of lidocaine hydrochloride and xylazine hydrochloride. Furthermore, this combination of treatments did not cause adverse effects in the cardiovascular and respiratory systems. These findings indicate that combined administration of procaine and xylazine is an economic and useful approach for epidural anesthesia.

Effect of transcutaneous electrical acupoint stimulation on pulmonary function and oxidative stress response in lower extremity surgery patients using tourniquet

To investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) on pulmonary function, superoxide dismutase (SOD) activity, and malondialdehyde (MDA) content in patients using tourniquet after lower extremity surgery. A total of 40 patients who underwent lower extremity surgery were equally randomized into control group and TEAS group by using a random number table. All patients underwent lumbar epidural anesthesia combined with block anesthesia. The patients in the TEAS group were given TEAS at Zusanli (ST36) and Sanyinjiao (SP6) beginning from 30 min before surgery to the end of surgery, and those in the control group received TEAS at the same acupoints with minimum current intensity. Mean arterial pressure (MAP) and heart rate (HR) were recorded at each time point (T0: pre-surgery /TEAS, T1: 5 min after anesthesia, T2: 1 min before tourniquet-loosening, T3: 1 min after tourniquet-loosening, T4: 5 min after tourniquet-loosening, and T5: 6 h after tourniquet-loosening). Blood samples (4 mL) was collected from the radial artery before TEAS and 6 h after loosening tourniquet for analyzing blood gas parameters as partial pressure of caron dioxide(PCO2), arterial partial pressure of oxygen (PaO2), alveolar partial pressure of oxygen (PAO2), alveolar-arterial oxygen pressure difference (PA-aDO2) and respiratory index (RI) by using a blood gas analyzer, and plasma SOD activity and MDA content were assayed by using xanthine oxidase method and thiobarbituric acid colorimetry method, respectively. Intra-group comparison showed that compared with T0, a significant increase was found in PA-aDO2 and RI at T5 and a significant reduction in PaO2 and PaO2/ PAO2 (a/A) ratio in the control group (P<0.05), and the same changes in the TEAS group (P<0.05) except a/A ratio. Comparison between two groups showed that at T5, both PaO2 and a/A levels were significantly higher in the TEAS group than in the control group (P<0.05), and both PA-aDO2 and RI levels were obviously lower in the TEAS group than in the control group (P<0.05), suggesting an improvement of the pulmonary function after TEAS. At T5, plasma SOD activity was significantly decreased and plasma MDA content was remarkably increased in the control group relevant to T0 (P<0.05), SOD activity was significantly higher in the TEAS group than in the control group (P<0.05), and MDA content was evidently lower in the TEAS group than in the control group (P<0.05), suggesting a reduction of oxidative stress response after TEAS. TEAS at ST36 and SP6 can improve pulmonary function and attenuate oxidative stress response in patients using tourniquet after lower extremity surgery.

Development of a Homemade Spinal Model for Simulation to Teach Ultrasound Guidance for Lumbar Puncture.

Spinal procedures such as lumbar punctures (LPs), epidurals, and spinal blocks are essential components to clinical practice but are challenging to teach, learn, or practice on real patients due to patient safety and comfort limiting the number of attempts. Resident physicians traditionally learn these spinal procedural skills through observation of a more senior physician before attempting the procedure. Simulation using models can improve providers' competency without introducing an added risk to patients. A difficulty encountered with access to simulation training for such procedures is the limited availability of simulators. While there are several high-quality, commercially available models that mimic the anatomy of lumbar spine, the cost of these models often limits the access to students and practitioners. The other challenge is access to simulators with versatility that can be used for palpation as well as ultrasound (US)-guided procedures. A simulator that can combine practice of both palpation and US-guided modalities would be efficacious in reducing cost to the teaching institutions. We attempted to overcome the access barrier to spinal models by developing an alternative that provides a good simulator for both palpation and US-guided LP while keeping the cost low. Our model can be easily manufactured by not only clinicians but also medical students. A literature review was conducted to assess the available research and information on the production and use of simulators for practicing LPs and other spinal procedures. Publications queried described the production of models and utilizing the information compiled we devised and fabricated a model. A lumbar spine model was developed using computed tomography spine data of an average-sized male patient without lumbar spine pathology. The model was created using medical imaging processing software and printed on 3D printer using nylon plastic. This model was then utilized by residents, advanced practice providers, and medical students for palpation and US-guided LP simulation training. An inexpensive reusable non-commercial LP simulator can be an effective method for teaching invasive procedures like LPs, especially if it can be used both for palpation and US-guided procedures. The method outlined here can be easily reproduced in a relatively short amount of time. We recognize one limitation in the widespread dissemination of this technique being access to a 3D printer and digital designs for printing. Future studies will be necessary to determine the efficacy of the homemade LP simulator in teaching neurointensivist in training.

Bleeding from lumbar ventral epidural venous plexus managed with hemostatic agent from oxidized non-regenerated cellulose

Bleeding from epidural blood vessels may be an unpleasant complication during surgery of the lumbar spine, which is often difficult to manage with electrocoagulation. The use of local hemostatic agents is apossible solution. This paper presents the first experience with an agent of oxidized non-regenerated cellulose. The agent of oxidized non-regenerated cellulose was used in 21 patients (12 women and 9 men) to stop bleeding from the ventral epidural lumbar venous plexus. It was always removed before the end of the operation. In all cases, bleeding was stopped within 2 minutes. Bleeding did not recur until the end of surgery (even after removal of the agent). No early or other complications were observed in the patients studied. The agent of oxidized non-regenerated cellulose appears to be arational and effective solution for bleeding from epidural veins in the lumbar spine.

Effect of dexmedetomidine combined with lumbar anesthesia on Th1/Th2 in maternal patients and neonates undergoing caesarean section.

The selection of anesthetic method and drugs is of utmost importance for patients undergoing caesarean section. The application of anesthetic drugs may affect the immune system of the maternal patient and neonate. Therefore, the present study aimed to analyze the effect of dexmedetomidine combined with lumbar anesthesia on type 1 T-helper cells (Th1) and Th2 cytokines in mothers and their neonates undergoing caesarean section. A total of 60 females with full-term pregnancies and an American Society of Anesthesiologists grade I or II who received caesarean section were selected and equally divided in a randomized manner into a control group receiving lumbar epidural anesthesia and a combination group treated by dexmedetomidine combined with lumbar epidural anesthesia. The visual analogue scale (VAS) score, adverse reactions, traction response and the neonates' Apgar score were compared between the two groups. The levels of interleukin-2 (IL-2), tumor necrosis factor-α (TNF-α), IL-4 and IL-10 in the blood of mothers and neonates were detected by reverse transcription-quantitative PCR and ELISA. The results indicated no statistically significant difference in the Apgar score between the two groups. The VAS scores, adverse reactions, reduced traction response, as well as IL-2 and TNF-α expression, in the mothers of the combination group were significantly decreased, while IL-4 and IL-10 were obviously elevated compared with those in the controls (P<0.05). Furthermore, IL-2 and TNF-α levels were markedly declined, whereas IL-4 and IL-10 expression was apparently enhanced in the neonates from the combination group compared with those in the control group (P<0.05). In conclusion, dexmedetomidine in addition to lumbar epidural anesthesia reduces the VAS score, adverse reactions and traction response, and promotes the conversion of Th1 cytokines to Th2 cytokines in mothers/nonates after caesarean section.

Hemodynamic Dimension Trend between Non Conversion and Conversion Lumbar Epidural Anesthesia to General Anesthesia Explored using Pulse Oximeter Technology

Hemodynamic Dimension Trend between Non Conversion and Conversion Lumbar Epidural Anesthesia to General Anesthesia Explored using Pulse Oximeter Technology

Pre-operative methylprednisolone decreased early vascular endothelial injury after total knee arthroplasty

Objective To investigate the effect of methylprednisolone on markers of early vascular endothelial activation and damage after total knee arthroplasty. Methods We randomly selected 88 patients undergoing unilateral total knee arthroplasty. The patients were divided into two groups by a completely random grouping method(n=44), they were given either pre-operative intravenous methylprednisolone 120 mg (number of patients for methylprednisolone group) or isotonic saline (number of patients for control group). All operations were performed under lumbar spinal and epidural anesthesia. Blood samples were collected at 2, 6, 12 h and 24 h pre- and post-operation, respectively. By enzyme-linked immunosorbent assay(ELISA), we analyzed concentrations of Syndecan-1, plasma soluble thrombomodulin (sTM), E-selectin, vascular endothelial growth factor (VEGF) and C-reactive protein (CRP) at different time points. Results There was no significant difference in age, gender, body mass index (BMI), operation time and ropivacaine dose between patients in two groups (P>0.05). Syndecan-1、E-selectin and CRP were significantly decreased at 2, 6, 12 h and 24 h in methylprednisolone group, sTM and VEGF were significantly decreased at 6, 12 h and 24 h in methylprednisolone group (P<0.05) . Compared with preoperative, the level of Syndican-1 and E-selectin at 2, 6, 12 h and 24 h were significantly decreased, the level of CRP was significantly increased (P<0.05) , the level of sTM and VEGF were significantly decreased at 6, 12 h and 24 h in methylprednisolone group (P<0.05) . Conclusions Pre-operative administration of methylprednisolone 120 mg could reduce markers of endothelial activation, reduce the level of damage markers and reduce the systemic inflammatory response after total knee arthroplasty. Key words: Total knee arthroplasty; Syndecan-1; Soluble thrombomodulin; E-selectin; Vascular endothelial growth factor; C-reactive protein

Volumetric evaluation of lumbar epidural fat distribution in epidural lipomatosis and back pain in patients who are obese: introducing a novel technique (Fat Finder algorithm)

ObjectiveSpinal epidural lipomatosis (EL) represents an excessive deposition of unencapsulated adipose tissue in the spinal canal that can result in chronic back pain in patients who are obese with and...

Skin-to-epidural distance in the Southeast Asian paediatric population: multiethnic morphometrics and international comparisons.

Paediatric epidurals can present technical challenges due to wide variations in age and weight among children, ranging from neonates to teenagers. This study evaluated the skin-to-epidural distance in the thoracic and lumbar regions to determine the relationship between age, weight and ethnicity and depth to the epidural space in our Singapore paediatric population. Data from the Acute Pain Service was prospectively collected over 16 years. Details included patient demographics, level of epidural performed and distance from skin to epidural space. Multivariable regression analysis was performed to determine the association of weight, age, ethnicity and gender with the depths to the thoracic and lumbar epidural spaces. A simple linear regression was calculated to predict the depth to both thoracic and lumbar epidural spaces based on body weight. Equations were formulated to describe the relationship between weight and depth of epidural space. A total of 616 midline epidurals were studied. Regression analysis was performed for 225 thoracic epidurals and 363 lumbar epidurals. Our study revealed a clear correlation between skin-to-lumbar epidural distance and weight in children. The best correlation was demonstrated between skin-to-lumbar epidural distance and body weight (R2 = 0.729). This relationship was described by the formula: depth (mm) = (0.63 × weight [kg]) + 9.2. Skin-to-lumbar epidural distance correlated with weight in children. Our results highlighted the clinical significance of differences between Southeast Asian paediatric populations when compared to other populations.

Prolonged sensory impairment in the perineal region after painless delivery through lumbar epidural anesthesia

AbstractIn the painless delivery, the neuronal injury caused by regional anesthesia sometimes causes diagnostic difficulty because of the common findings with lumbosacral injury due to vaginal delivery. We herein report a 36‐year‐old woman presenting with long‐standing cauda equina syndrome due to neurotoxicity of regional anesthetic. Neurological examination revealed the almost symmetrical, heterogeneous sensory deficit mainly in the perineal region, hypoactive quadriceps femoris reflex, decreased anal sphincter reflex, and dermographia. The correct diagnosis is important to support the quality of life of patients.

Surveying the Literature

Surveying the Literature

Posterior epidural disc fragment masquerading as spinal tumor: Review of the literature

Posterior epidural lumbar disc fragment is infrequent because of anatomical barriers, and it is difficult to diagnose posterior epidural lumbar disc fragment because of its rare incidence and the ambiguity of radiologic evaluations. And it is difficult to differentiate it from other diseases such as spinal tumors. Differential diagnosis of posterior epidural lumbar disc fragment is clinically important because its diagnosis can affect treatment and prognosis. To investigate the incidence, anatomical concern, etiology, symptom, diagnostic tool, management and prognosis of posterior epidural lumbar disc fragment, we reviewed articles including case report. We performed a search of all clinical studies of posterior epidural lumbar disc fragment published to date. The following keywords were searched: Posterior epidural lumbar disc fragment, disc migration, posterior epidural disc, extradural migration, dorsal epidural migration, sequestrated disc, and disc fragment. We identified 40 patients of posterior epidural lumbar disc fragment from 28 studies. The most common presentation of posterior epidural lumbar disc fragment was sudden onset radiculopathy (70.0%), followed by cauda equina syndrome (27.5%). The most frequently used diagnostic modality was magnetic resonance imaging (MRI), conducted in 36 cases (90.0%), and followed by computed tomography in 14 cases (35.0%). After the imaging studies, the preoperative diagnoses were 45.0% masses, 20.0% lesions, and 12.5% tumors. Characteristic MRI findings in posterior epidural lumbar disc fragment are helpful for diagnosis; it typically displays low signals on T1-weighted images and high signals on T2-weighted images with respect to the parent disc. In addition, most of the disc fragments show peripheral rim enhancement on MRI with gadolinium administration. Electrodiagnostic testing is useful for verifying nerve damage. Surgical treatment was performed in all cases, and neurologic complications were observed in 12.5%. As posterior epidural lumbar disc fragment could be masqueraded as spinal tumor, if rim enhancement is observed in MRI scans with sudden symptoms of radiculopathy or cauda equina syndrome, it should be taken into consideration. Early diagnosis can lead to early surgery, which can reduce complications.

Labor Analgesia Onset With Dural Puncture Epidural Versus Traditional Epidural Using a 26-G Whitacre Needle and 0.125% Bupivacaine Bolus: A Randomized Clinical Trial

(Anesth Analg. 2018;126:545–551) Lumbar epidural (LE) and combined spinal epidural are 2 techniques commonly used for labor analgesia. However, they are not without their disadvantages. An alternative may be the dural puncture epidural (DPE) technique, which allows medication to migrate into the intrathecal space via the epidural space. In the present study, the authors evaluated neuraxial labor analgesia onset following epidural bolus with a dilute local anesthetic solution (0.125% bupivacaine with 50 μg fentanyl) in active laboring parturients with and without DPE. The primary outcome of this study was the percentage of parturients in each group with adequate analgesia during active contraction 10 minutes after administering the epidural bolus.

Area Under the Curve of Finger Photoplethysmography as an Evaluation Measure for Sympathetic Activity During Lumbar Epidural Anaesthesia.

To detect changes in finger photoplethysmography after administration of epidural anaesthesia as a surrogate method for evaluating autonomic nervous system activity. We included a total of 46 patients scheduled for elective surgical procedures under lumbar epidural anaesthesia. A Biopac SS4LA pulse plethysmograph transducer was used for photoplethysmography recording, and the device was placed on the first toe of the right leg. The first standard lead of the electrocardiogram was simultaneously measured with the finger photoplethysmography. First measurement was done before the administration of epidural anaesthesia, and second measurement was done 25 minutes post administration of epidural anaesthesia. The area under the curve of the finger photoplethysmography statistically significantly increased 25 minutes after administration of epidural anaesthesia compared with the first measurement (p=0.0001). The amplitude of the finger photoplethysmography as well as the pulse transit time also statistically significantly increased after administration of epidural anaesthesia. The area under the curve reflects the changes in sympathetic activity after epidural anaesthesia below the block level. It can be used for the detection of the degree of sympathetic block and, respectively, for epidural block success. Future prospects include detection of sympathetic block cessation as an indicator for discharge from the awakening room and beginning of patient verticalisation.

Application of continuous iliac fascial interstitial obstruction in the placement of anaesthesia in the vertebral canal of the elderly femoral fractures and postoperative analgesia

Objective To investigate the effect of continuous iliac fascia space block on the placement of body position and postoperative analgesia in patients with femoral fractures. Methods 60 patients with senile selective unilateral femoral fracture, aged 68-87 years old, weight 49-70kg, ASA grade II-III were selected, and they were randomly divided into iliac fascia block group (A group) and intravenous analgesia group (B group) according to the digital, 30 cases in each group.The two groups underwent lumbar epidural anesthesia, A group received continuous fascia iliaca compartment block 15 min before the the body position.B group was routinely given combination of lumbar and hard anesthesia.After operation, A group was connected with the automatic infusion pump continuous infusion of 0.2% ropivacaine 0.1mL·kg-1·h-1.B group received controlled intravenous analgesia, postoperative given loading dose of dezocine intravenous infusion of 5mg with automatic injection pump for dezocine 0.01mg·kg-1·h-1.When the patients entered the room (T0) and just after the placement of the body position (T1), the heart rate, diastolic blood pressure and systolic blood pressure were measured and recorded.At postoperative 2, 4, 6, 12, 24 and 48h, the VAS scores and pethidine usage during surgery, the adverse reaction were recorded. Results The heart rate, diastolic pressure and systolic pressure at T1 in A group had no significant change compared with T0 (all P>0.05). The heart rate, diastolic pressure and systolic pressure in the control group (B group) at T1 were significantly higher than at T0(t=5.302, 7.369, 5.629, all P<0.05). At T1, T2, T4, T6, T12, T24 and T48, the pain VAS scores in A group were lower than those in B group (t1=66.401, t2=7.719, t4=25.260, t6=13.170, t12=3.837, t24=3.081, t48=6.202.all P<0.05). The study group had no complications such as puncture hematoma, intoxication of local anesthetic and other complications. Conclusion Continuous iliofascial block can provide continuous analgesia for elderly patients with femoral fractures.It is safe and effective, and is easy to perform.It provides favorable conditions for later operative treatment. Key words: Iliac fascia space block; Femoral fracture; Elderly; Postoperative analgesia

Use of platelet transfusions prior to lumbar punctures or epidural anaesthesia for the prevention of complications in people with thrombocytopenia.

Use of platelet transfusions prior to lumbar punctures or epidural anaesthesia for the prevention of complications in people with thrombocytopenia.

Risk Factors for Thirty-Day Morbidity and Mortality in Extradural Lumbar Spine Tumor Resection.

Epidural tumors in the lumbar spine represent a unique cohort of lesions with individual risks and challenges to resection. Knowledge of modifiable risk factors are important in minimizing postoperative complications. To determine the risk factors for 30-day morbidity and mortality in patients undergoing extradural lumbar tumor resection. A retrospective study of prospectively collected data using the American College of Surgeons National Quality Improvement Program database was performed. Adults who underwent laminectomy for excision of lumbar spine tumors between 2011 and 2014 were included in the study. Demographics and medical comorbidities were collected, along with morbidities and mortalities within 30 postoperative days. A multivariate binary logistic analysis of these clinical variables was performed to determine covariates of morbidity and mortality. The database search yielded 300 patients, of whom 118 (39.3%) were female. Overall, complications within 30 days of surgery occurred in 102 (34%) patients. Significant risk factors for morbidity included preoperative anemia (P < 0.0001), the need for preoperative blood transfusion (P= 0.034), preoperative hypoalbuminemia (P=0.002), American Society of Anesthesiologists score 3 or 4 (P= 0.0002), and operative time >4 hours (P < 0.0001). Thirty-day mortality occurred in 15 (5%) patients and was independently associated with preoperative anemia (odds ratio 3.4, 95% confidence interval 1.8-6.5) and operative time >4 hours (odds ratio 2.6, 95% confidence interval 1.1-6.0). Excision of epidural lumbar spinal tumors carries a relatively high complication rate. This series reveals distinct risk factors that contribute to 30-day morbidity and mortality, which may be optimized preoperatively to improve surgical safety.

Lumbar epidural depth using transverse ultrasound scan and its correlation with loss of resistance technique: A prospective observational study in Indian population.

Background and Objectives:The objective of the present study was to evaluate the skin-epidural space distance as assessed by ultrasonography and conventional loss of resistance (LOR) technique and to find the correlation of epidural depth with body mass index (BMI).Methods:Ninety-eight patients of either sex, American Society of Anesthesiology I/II, BMI <30 kg/m2 requiring lumbar epidural for surgery were enrolled. The epidural space was assessed with a curvilinear ultrasound (US) probe, 2–5 MHz, in the transverse plane at L3–L4 intervertebral space. Thereafter, the epidural depth from skin was assessed with conventional LOR method while performing the epidural. The needle depth (ND) was measured using a sterile linear scale, and any change in the needle direction or intervertebral space was noted.Results:The patients were demographically similar. Depth of epidural space measured by US depth (UD) was 3.96 ± 0.44 cm (range 3.18–5.44 cm) and by ND was 4.04 ± 0.52 cm (range 2.7–5.7 cm). The Pearson's correlation coefficient (r) between UD and ND was 0.935 (95% confidence interval: 0.72–0.92, r2 = 0.874, P < 0.001), and Bland–Altman analysis revealed the 95% limits of agreement −0.494–0.652 cm.Conclusion:The present study demonstrates a good correlation between UD and ND and shows that the preprocedural US scan in transverse plane provides accurate needle entry site with a high success rate in single attempt for lumbar epidurals in patients with a BMI <30 kg/m2.

Haptic forces and gamification on epidural anesthesia skill gain

Epidural anesthesia is a blind medical procedure, where the needle insertion is a critical step. Its correct placement and location is related to the tactile perception and the loss of resistance (LOR) of tissues inside the epidural lumbar region, in order to avoid the puncture of the dura-mater membrane. Skill development and maintenance occurs through continuous practice. The main objective of this work is the development of a virtual simulator to enhance the training on the epidural anesthesia, in order to reduce the high failure rate currently reported on these medical procedures. This simulator integrates the development of the following 3 new models: (1) a force-displacement model to cover the progression of resistance forces generated by tissues along the needle insertion, based on real experiment data; (2) a force-needle model, to calculate the axial forces produced by needle deflection upon insertion, based on experiment data; and (3) a tissue model to design the thickness for each tissue on the simulator, from patient height, weight and age, based on average body measurements. The developed models added more realism when compared to previous works. The force-displacement model considers stiffness, friction and cutting forces for each tissue on epidural region, and includes a representation of needle insertion stages before and after the puncture in the behavior of each tissue. Other force models did not consider force modifiers for needle deflection before. The simulator environment implements the integration of a haptic device to control the needle movement, manipulated by the user. These devices enable to reproduce the resistance generated by the developed models providing physical feedback to user movements, to emulate sensations and reactions from the bypassed tissues (skin, fat, spinal ligaments, epidural space and dura-mater), as if those actions were executed in a real patient. The haptic device used presents six degrees of freedom (DOF), allowing translations and rotations on three axes (x, y, and z). The simulator interface was improved by incorporation of points and achievements as gamification elements to enhance the user interaction. These elements may contribute for maintenance of the trainee activity along the procedure practices, and to motivate and stimulate the student learning and skill improvement. No work have employed gamification elements on the interface of epidural simulators before.

English

INTRODUCTION: Epidural anesthesia was first performed by Spanish military surgeon Fidel Pages in 1921 in lumbar region. In 1949 Curbelo used Tuohy equipment for continuous blockade. The epidural technique became popular as it had some specific advantages over spinal anaesthesia. The feasibility of extended duration and differential blockade extended its application into other fields like post operative analgesia, chronic pain relief and obstetric pain relief. But some inherent negative points of epidural technique like delayed onset and patchy analgesia persist. Various attempts have been made to rectify these negative points. Combined spinal-epidural technique got introduced in an attempt to rectify this and has become popular. Various additive drugs have been tried along with local anaesthetics in an attempt to hasten the blockade to improve the quality of block. Among drugs that have been tried, magnesium sulphate deserves special mention. Even though magnesium sulphate has been used for various other purposes, its entry into anaesthetic arnamentorium is new. Magnesium sulphate has been described to possess various properties. The potentiation of local anaesthetic drugs is one among them. So my study aims to evaluate the effect of its addition to local anaesthetic in epidural blockade. Along with local anesthetic agent other additive drugs are Epinephrine, Clonidine, Dexmedetomidine, Neostigmine, Ketamine, and Benzodiazepines. Magnesium sulphate a potent antagonist of NMDA receptors when used epidurally is claimed to hasten the onset of sensory blockade. Magnesium also causes physiological Calcium channel blockade and decreases the postoperative opioid requirements. AIM OF THE STUDY: Sole epidural Bupivacaine is becoming unpopular due to delayed onset of sensory blockade. The aim of the study is to add magnesium sulphate as an adjunct to epidural Bupivacaine and evaluate 1. The impact of Magnesium sulphate on the quality of the block using the following parameters, a. Onset of sensory blockade, b. Motor blockade quality, c. Two segment regression time, d. Post-Operative analgesia. 2. Impact of Magnesium sulphate on hemodynamic changes. MATERIALS AND METHODS: After approval of the study by our institutional ethics committee, the study was conducted on 50 ASA grade I or II patients undergoing elective lower abdominal surgeries. Lumbar epidural anesthesia was performed to all the patients. The age of the patients ranged from 23- 70 weighing 45-80 kg and height ranging from 150 – 172 cm. all patients were thoroughly examines preoperatively. Informed consent was obtained from all of them. In the assessment room, vital parameters like pulse, blood pressure, and base line investigations like hemoglobin, urine analysis for albumin and sugar, blood sugar ,urea and creatinine and Electrocardiogram were checked. Thorough examination of all the systems and airway assessment was done. Exclusion criteria including significant co-existing diseases , long term analgesic use, and contraindications to regional anaesthesia such as local infection and bleeding diathesis. The patients were randomly allotted to 2 groups each containing 25. Group C: Patients received 19ml of 0.5 % Bupivacaine + 1 ml normal saline. Group S: Patients received 19ml of 0.5 % Bupivacaine + 50 mg of magnesium sulphate at L2-L3 space using 17G Tuohy needle and placing epidural catheter at 8 cm. SUMMARY: We conducted a double blinded randomized controlled study in 50 patients belonging to ASA I and II undergoing elective lower abdominal surgeries to evaluate the effect of adding magnesium sulphate to bupivacaine and bupivacaine alone in epidural anaesthesia in KAPV Govt Medical college hospital. For the same reason, we divided randomly the patients into two groups of 25 each. Group C received 19 ml of 0.5% of bupivacaine (95mg) and 1ml of Normal saline. Group S received 19 ml of 0.5% of bupivacaine (95 mg) and 1ml of Magnesium sulphate (50 mg). The total volume of the injected solution was 20 ml in both groups. The onset of sensory and motor blockade, the duration of post-operative analgesia were noted in the both the groups. Demographic data were similar in both the groups. We found the onset of sensory blockade was faster in the magnesium group. The duration of post-operative analgesia was slightly prolonged in the study group. The incidence of side effects were similar in both the groups. There is no difference in the change in heart rate and the episode of hypotension were also similar in both the groups. CONCLUSION: This study concludes that epidural magnesium sulphate when added to bupivacaine will shorten the onset of sensory blockade significantly in patients undergoing elective lower abdominal surgeries without increasing the incidence of side effects.