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Epidural Volume Extension During Combined Spinal-Epidural Labor Analgesia Does Not Increase Sensory Block

Zaphiratos, Valerie MD, MSc, FRCPC; George, Ronald B. MD, FRCPC; Macaulay, Bruce MD, FRCPC; Bolleddula, Prasad MD, FRCA; McKeen, Dolores M. MSc, MD, FRCPC

doi: 10.1097/01.aoa.0000512034.19979.0e
Anesthesia and Analgesia: Regional Analgesia
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Commentary

(Anesth Analg. 2016;123:684–689)

Combined spinal-epidural (CSE) provides faster and better first-stage analgesia and fewer epidural top-up boluses than traditional epidural methods. Deliberate injection into the epidural space can increase anesthetic level. This mechanism, referred to as epidural volume extension (EVE), is not fully understood; the fluid in the epidural space may be compressing the dural sac. The current authors thus tested 2 hypotheses. First, an epidural injection of 10 mL normal saline while initiating CSE would increase the initial anesthetic sensory block height by 15 minutes. Second, compared with CSE alone, CSE with EVE would result in a higher sensory block at 30 minutes while decreasing pain scores, analgesia onset time, and motor block.

Department of Women’s and Obstetric Anesthesia, IWK Health Centre, Dalhousie University, Halifax, NS, Canada

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