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BJA Advance Access originally published online on July 22, 2005
British Journal of Anaesthesia 2005 95(4):500-503; doi:10.1093/bja/aei200
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org

Effect of epidural volume extension on dose requirement of intrathecal hyperbaric bupivacaine at Caesarean section

N. Beale1, B. Evans1, F. Plaat1, M. O. Columb2, G. Lyons3 and G. M. Stocks1,*

1 Queen Charlotte's and Chelsea Hospital, London, UK. 2 South Manchester University Hospital, Wythenshawe, Manchester, UK. 3 St James' University Hospital, Leeds, UK

* Corresponding author. E-mail: gstocks{at}hhnt.org

Background. The technique of epidural volume extension (EVE) involves the injection of saline into the extradural space immediately following the intrathecal injection, as part of a combined spinal-epidural (CSE) anaesthetic. One of the suggested benefits of EVE is a reduction in local anaesthetic required. The aim of this study was to test this hypothesis by comparing the median effective doses (ED50) of hyperbaric bupivacaine with fentanyl 25 µg with and without EVE for Caesarean section.

Methods. Sixty women were randomized to receive either CSE anaesthesia with EVE (EVE group) or no EVE (NEVE group). Using a double-blinded, up-down sequential technique, varying doses of bupivacaine with fentanyl 25 µg were administered. ED50 was estimated from up-down reversals and probit regression.

Results. The ED50 for bupivacaine was similar and not significantly different in the two groups (5.1 mg in the EVE and 6.1 mg in the NEVE group; difference 1.0 mg, 95% CI –0.12 to 2.2, P=0.08).

Conclusions. This study illustrates that whilst low doses of intrathecal bupivacaine can be effectively used for Caesarean section, at such doses EVE does not appear to offer reliable or clinically relevant reductions in dosing with intrathecal bupivacaine.


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E-letters:

Read all E-letters

Role of CSE in Elective Caesarian Section
Andrew Stapleton
British Journal of Anaesthesia, 12 Oct 2005 [Full text]
Why doesn't fluid spill out after "epidural volume extension" ?
Prasanna N Tilakaratna
British Journal of Anaesthesia, 27 Nov 2006 [Full text]
Reply to Dr Tilakaratna
Gary M Stocks, et al.
British Journal of Anaesthesia, 7 Dec 2006 [Full text]

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