A randomized controlled trial on epidural volume extension in combined spinal epidural anesthesia for lower limb surgeries using intrathecal ropivacaine in older adults

Abstract

Background: Epidural volume extension (EVE) is a technique wherein normal saline is injected into epidural space, soon after the neuraxial block. We studied the effectiveness of EVE using intrathecal ropivacaine and normal saline in the elderly. Patients and Methods: This was randomized, control, double-blinded, double arm, parallel study of 75 patients of American Society of Anesthesiologists I and II, age ≥60 years, undergoing lower limb orthopedic surgery. Patients were allocated into two groups (E and NE), both receiving 3 ml of 0.75% injection ropivacaine intrathecally. Group E also received EVE. The primary outcome was the maximum level of sensory block. Secondary outcomes were the characteristics of blocks, hemodynamic changes, adverse effects, and analgesic requirements until 24 h. The statistical analysis of quantitative data was done by the Student's t-test and that of qualitative data using the Chi-square test. Results: The sensory level of block achieved in Group E T4(T2–T5) was higher as compared to Group NE, T6(T3-T8). Time to two-segment sensory regression was earlier in Group NE (mean = 66.5 min; 95% confidence interval [CI], 63.31–69.69) than in Group E (mean = 91.5 min; 95% CI, 87.70–95.31) (P < 0.001; df = 58). The duration of analgesia in Group E (mean = 316.5 min; 95% CI, 309.09–323.91) was more than in Group NE (mean = 230.67 min; 95% CI, 226.49–234.850) (P < 0.001). There was no statistically significant difference in the 24 h analgesic consumption (P = 0.64), hemodynamic stability, or adverse effects. Conclusion: EVE results in a higher level of the sensory block and a longer duration of postoperative analgesia than that without EVE with no hemodynamic instability in the older population.

Keywords

• epidural space
• hemodynamic stability
• local anesthetic
• pain management
• ropivacaine