The epidural top-up: Predictors of increase of sensory blockade

• Published in: Anesthesiology (Philadelphia) Vol. 96; no. 6; pp. 1310 - 1314
• Main Authors: LEEDA, Michal, STIENSTRA, Rudolf, SESMU ARBOUS, M, VERSCHURE, Maarten J. M, DAHAN, Albert, VEERING, Bernadette Th, VAN KLEEF, Jack W, BURM, Anton G. L
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01.06.2002
• Subjects: Adult; Aged; Aged, 80 and over; Amides - cerebrospinal fluid; Anesthesia; Anesthesia, Epidural - methods; Anesthesia, Spinal - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Double-Blind Method; Female; Humans; Local anesthesia. Pain (treatment); Male; Medical sciences; Middle Aged; Prognosis; Ropivacaine; Sensation; Local anesthetic; Human; Regional anesthesia; Extradural administration; Organic amide; Ropivacaine; Technique
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/00000542-200206000-00008

Extension of sensory blockade after an epidural top-up in combined spinal epidural (CSE) anesthesia is partly attributed to compression of the dural sac by the injected volume. This study investigated whether a volume effect plays a significant role when administering an epidural top-up after an initial epidural loading dose and assessed the predictive value of different factors with respect to the increase in sensory blockade. After an epidural loading dose of 75 mg ropivacaine, 0.75%, 30 patients were randomly assigned to one of three groups. After the maximum level of sensory blockade (MLSB) had been established, patients received either an epidural top-up with 10 ml ropivacaine, 0.75% (group 1, n = 10) or saline (group 2, n = 10), or no epidural top-up (group 3, n = 10). Subsequently, sensory blockade was assessed at 5-min intervals for a further 30 min by a blinded observer. The MLSB increased significantly in the patients receiving an epidural top-up with ropivacaine but not in the patients receiving normal saline. Sensory block extension was inversely related to the number of segments blocked at the time of the epidural top-up, and female gender was associated with a smaller increase in MLSB. When using epidural ropivacaine, the extension of sensory blockade after administering an epidural top-up is caused by a local anesthetic effect and not by a volume effect. Under the conditions of this study, predictors of the increase in sensory blockade are the presence of ropivacaine in the top-up injectate, the number of segments blocked at the time of epidural top-up, and gender.