Deepak Bharat Kawade, Shubhada Rajendra Deshmukh, Noopur Borkar


BACKGROUND: Prolonged motor and sensory block following Central Neuraxial Blockade (CNB) is associated with
extended postoperative immobilization and its complications. Speedy recovery from motor blockade would improve the
patients' acceptance of neuraxial anesthesia.
Previous studies in patients undergoing epidural anaesthesia, demonstrated rapid motor recovery after administration of epidural crystalloids.
We studied the effect of intermittent bolus injection of Normal saline (NS) on the duration of sensory and motor recovery after Combined spinal
epidural anaesthesia (CSEA).
METHODS:60 patients (ASA I-III) scheduled for surgeries under CSEA lasting for 1½ to 2 hrs were divided equally by systematic random
sampling at the end of surgery.
Control group - No bolus of NS flush was given through the epidural catheter.
Intervention group -15 ml of NS flush through epidural catheter was given thrice.
Sensory level, Motor blockade and vitals were noted at 5 min interval for 2 hours from end of surgery.
1. Sensory levels in two groups were significantly different (p-value < 0.001) at the end of two hours. In intervention group, T8 level was
predominant, while in control group L1 level was predominant.
2. Difference in motor block in two groups was significant as (p-value < 0.001). In intervention group, 86.67% had Bromage score 0, while in
control group 80% had score 1 at the end of 2 hrs.
Conclusion: Postoperative epidural flush with 45 ml Normal saline hastened the motor recovery following CSEA without shortening of the
duration of sensory blockade.

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Chirayath J, Dhanpal R. Evaluation of The Effects Of An Epidural Top-Up In Combined Spinal Epidural Anaesthesia. Indian Journal of Anaesthesia. 2002 Jun: 198.

Ong KB, Sashidharan R. Combined spinal–epidural techniques. Continuing Education in Anaesthesia, Critical Care & Pain. 2007 Apr 1; 7(2):38-41.

Maria Williams L.T,Tiffany Dodson,,aug 2011.effect of epidural normal salinebolus prior to catheter removal on parturient sensory and motor function recovery ;a pilot study.AANA journal ,aug,2011,vol 79,no 4.

Attia J, Mohamed A, Bader Y. Effect of Normal Saline Bicarbonate on Reversing Epidural Anesthesia Either with Bupivacaine Or Bupivacaine and Nalbuphine in Patients Undergoing Orthopedic Surgery. Advances in Anesthesiology. 2015 Mar 2; 2015.

Sitzman BT, DiFazio CA, Playfair PA, et al. Reversal of lidocaine with epinephrine epidural anesthesia using epidural saline washout. Reg Anesth Pain Med. 2001;26(3):246-251.

Katircioglu K, Ozkalkanli MY, Kalfaoglu H, Sannav S, Ozgurbuz U, Savaci S. Reversal of prilocaine epidural anesthesia using epidural saline or Ringer’s lactate washout. Regional anesthesia and pain medicine. 2007 Sep 30;32(5):389-92.

Miller R. Miller’s Anesthesia. 8th ed Philadelphia:ELSEVIER SAUNERS;2015; 56; 1703.

Brock-Utne JG, Macario A, Dillingham MF, Fanton GS. Postoperative epidural injection of saline can shorten postanesthesia care unit time for knee arthroscopy patients. Regional anesthesia and pain medicine. 1998 May 1;23(3):247-51.

Gissen AJ, Covino BG, Gregus J. Differential sensitivities ofmammalian nerve fibers to local anesthetic agents. Anesthesiology.1980; 53:467-74.

Corke BC, Carlson CG, Dettbarn WD. The influence of 2-chloroprocaine on the subsequent analgesic potency of bupivacaine.Anesthesiology 1984;60:25-7.

Johnson MD, Burger GA, Mushlin PS, Arthur GR, Data S. Reversal ofbupivacaine epidural anesthesia by intermittent epidural injections of crystalloid solutions. Anesth Analg. 1990;70(4):395-399.

Rodriguez J, Rodriguez V, Naveira A, Quintela O, Barcena M, Gallardo E, Gude F, Alvarez J. Epidural washout with high volumes of saline to accelerate recovery from epidural anaesthesia. Acta anaesthesiologica scandinavica. 2001 Jul 1; 45(7):893-8.

Couture D. Effects of a 30-mL Epidural Normal Saline Bolus on Time to Full Motor Recovery in Parturients Who Received Patient-Controlled Epidural Analgesia With 0.125% Bupivacaine With 2 µg/mL of Fentanyl. AANA journal. 2016 Jun 1; 84(3).

Chan VW, Nazarnia S, Kaszas Z, Perlas A. The impact of saline flush of the epidural catheter on resolution of epidural anesthesia in volunteers: a dose-response study. Anesthesia & Analgesia. 1999 Oct 1;89(4):1006.

Ave NK, Shoeibi G, Moharnrnadi SS, Marashi M. Comparing Sodium Bicarbonate with Normal Saline for Reversing of Epidural Anesthesia with Plain 2% Lidocaine. J. Med. Sci. 2007;7(5):892-6.

Wong C, Salinas F. Spinal and Epidural Anasthesia. 1st ed. United State of America: McGraw-Hill Companies;2007 3-91.

Higuchi H, Hirata JI, Adachi Y, Kazama T. Influence of lumbosacral cerebrospinal fluid density, velocity, and volume on extent and duration of plain bupivacaine spinal anesthesia. The Journal of the American Society of Anesthesiologists. 2004 Jan 1;100(1):106-14.

Park, E. Y., Kil, H. K., Park, W. S., Lee, N.-H. and Hong, J.-Y. (2009), Effect of epidural saline washout on regression of sensory and motor block after epidural anaesthesia with 2% lidocaine and fentanyl in elderly patients. Anaesthesia, 64: 273–276. doi:10.1111/j.1365-2044.2008.05746.x


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