Comparison of Different Volumes of Normal Saline for Epidural Volume Extension in Combined Spinal Epidural Anesthesia for Lower Abdominal Surgeries

Peak sensory block height, highest Bromage score, time taken to achieve maximum sensory and motor block and the time to their recovery were recorded.Statstical Analysis. was done using statistical software SSPS version 16.0 and Epi- info version 6.0 .Outcome measures were presented as % for qualitative variables and mean±SD for quantitative variables.Demographic data and duration of surgery were similar in all the groups.Sensory block augmentation was found to be significantly higher in the EVE10 and EVE 20 groups. EVE with saline is distinct from the block enhancement after an epidural top-up of local anaesthetic in that saline extends the block height by a mechanical "volume effect" and does not prolong the block duration.The volume effect appears to be time dependent as beyond 30 minutes or after two-segment regression has begun, any epidural top-up of saline would have no effect on block extension and may even accelerate spinal block regression.The advantage of this EVE technique is that a small-dose spinal block may provide an adequate level of anaesthesia while allowing faster motor recovery of the lower limbs. Material and Methods After approval by the Institutional Ethical Committee (IEC) and obtaining written informed consent,120 women aged between 20-60 years, belonging to ASA grade I-II with height between 150 to 175 cms undergoing elective lower abdominal surgeries were included in this study.The patients were randomly allocated into 3 groups and each group comprised of 40 patients. GROUP 1: 10 mg 0.5% bupivacaine heavy (H) + E pidural volume extension with 5 ml normal saline (EVE 5) GROUP 2: 10 mg 0.5% bupivacaine (H) + Epidural volume extension with 10 ml normal saline (EVE 10) GROUP 3: 10 mg 0.5% bupivacaine - (H) +Epidural volume extension with 20 ml normal saline (EVE 20) Exclusion criteria included patient refusal, ASA III or more, coagulopathies, hypersensitivity to the study drug and any contraindication to regional anaesthesia.