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Journal of Obstrectic Anaesthesia and Critical Care
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Year : 2012  |  Volume : 2  |  Issue : 1  |  Page : 16-22

Comparison of hydroxyethyl starch versus normal saline for epidural volume extension in combined spinal epidural anesthesia for cesarean section

Department of Anaesthesiology and Critical Care, RNT Medical College, Udaipur, Rajasthan, India

Correspondence Address:
Sunanda Gupta
26, Navratna Complex, Bedla Road, Udaipur-313004, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2249-4472.99310

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Background: Epidural volume extension (EVE) with saline in the epidural space during a CSE technique can result in cephalad extension of the block and may be accompanied by episodes of hypotension. It also allows CSE to be performed with small initial intrathecal doses of local anesthetic. Objectives: We investigated the difference in block characteristics and hemodynamic profile with CSE-EVE using either saline or colloid in the epidural space. Materials and Methods: This prospective, randomized, controlled study was conducted in 99 parturients, ASA grade I or II, with gestational age 37 weeks or more, undergoing elective cesarean section under CSEA. Women were randomly distributed into three groups: Group NEVE (CSE with no EVE), Group EVE-S (CSE followed by EVE using 5 ml of 0.9% saline), and Group EVE-H (CSE followed by EVE using 5 ml of 6% hydroxyethyl starch (HES) 200/0.5). All the groups received 6 mg of 0.5% hyperbaric bupivacaine with 25 mcg fentanyl intrathecally, while Groups EVE-S and EVE-H also received 5 ml of saline or HES in the epidural space. All blocks were performed using needle through needle CSE technique via midline approach at the L 4-5 interspace with the women in the left lateral position. Block characteristics and hemodynamic parameters were recorded by an independent anesthesiologist. Data were compared with Chi-square, t test, and ANOVA using Epi info 6 with P < 0.05 as significant. Results: The peak sensory level and the time taken to achieve it was significant in Group EVE-S (P = 0.003 temperature, P = 0.007 pinprick, P = 0.000 time) as compared to Group NEVE while Group EVE-H was intermediate as compared to the other two groups. In Group EVE-S, there was a difference in the mean peak sensory levels as assessed by temperature (thoracic T 4.88±1.01 ) and pinprick (T 5.04±1.02 ), whereas it was the same in the other two groups (T 6.10±1.41 in Group NEVE and T 5.44±1.35 in Group EVE-H). The requirement for ketamine supplementation was significantly more in Group NEVE (54.5%) as compared to Group EVE-S (24.2%) and Group EVE-H (27.3%), P = 0.018. The motor block characteristics were comparable in all the three groups (P > 0.05).The lowest attained values of heart rate, systolic, and diastolic blood pressure were significantly less in Group EVE-S versus Group NEVE (P = 0.019, 0.008, and 0.001, respectively), while hemodynamic parameters in Group EVE-H were intermediate. Incidence of hypotension was significantly more in Group EVE-S (n = 20, 60.6%), as compared to Group NEVE (n = 9, 27.3%, P = 0.02) and Group EVE-H (n = 13, 39.4%). Conclusion: We conclude that an intrathecal dose of 6 mg hyperbaric bupivacaine with 25 mcg fentanyl is adequate for cesarean section when used in CSE with the EVE technique, using 0.9% saline or 6% HES. However, EVE with HES provides optimal hemodynamic profile as compared to EVE with saline.

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