Background and goals of the study: Duration of neuraxial blocks can outlast duration of surgery. Infusion of saline into the epidural space after surgery has been proposed as a mean to accelerate recovery after epidural anaesthesia (EA) [1-3]. We studied if the infusion of a higher volume of saline can provide a faster recovery.
Materials and methods: Prospective, randomized, controlled double blind study. Thirty patients were randomly assigned to control group, to group 2× (epidural infusion with twice the volume of 2% mepivacaine given to reach a sensory level of T4-T6) and group 4× (epidural infusion with four times the volume of 2% mepivacaine). Recovery was assessed with TOF stimulation at T10 and L2 for sensory blockade and with a modified Bromage's scale for motor blockade. Mepivacaine plasma levels were studied. Kruskal-Wallis nonparametric test, one-way ANOVA followed by Bonferroni's test and Student's t-test for paired data followed by Bonferroni's correction and colleagues were used when appropriate.
Results and discussion: Groups were similar for weight, age and dose of mepivacaine. A significant decrease in the duration of sensory blockade in groups 2× and 4× was found when compared with control group. No difference was found between infusion groups. TABLE
One patient in group 4× presented transient symptoms of intracranial hypertension. Mepivacaine plasma levels increased significantly in group 4× after saline infusion.
Conclusion: Saline infusion seems to have a maximum effective dose in shortening duration of EA. High volumes of saline increase systemic uptake of the local anaesthetic and can produce intracranial hypertension.
1 Brook Utne JG, Macario A, Dillingham MF et al. Reg Anesth Pain Med
2 Johnson MD, Burger GA, Mushlin PS et al. Anesth Analg
3 Chan VWS, Nazarnia S, Kaszas Z et al. Anesth Analg
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