The Influence of Epidural Volume Extension on Spinal Block with Hyperbaric Bupivacaine for Elective Lower Limb Orthopaedic Surgical Procedures

Background: Epidural Volume Extension (EVE) has been studied as a modification to the combined spinal epidural (CSE) technique to enhance the effectiveness of spinal anesthesia. The addition of EVE aims to improve sensory blockade levels while reducing the dose of intrathecal anesthetic. This study investigates the influence of EVE on spinal block with hyperbaric bupivacaine in elective lower limb orthopedic surgical procedures. Objective: The primary aim of this study was to determine if the use of EVE could achieve a higher sensory block and more stable hemodynamic parameters in comparison to traditional CSE without EVE. Methods: A prospective, randomized, comparative study was conducted with 60 patients scheduled for elective lower limb orthopedic surgeries. Patients were divided into two groups: Group I (CSE with EVE) and Group II (CSE without EVE). Both groups received 10 mg injection hyperbaric bupivacaine intrathecally, with Group I additionally receiving 10 mL of saline via an epidural catheter for volume extension. Sensory and motor block characteristics were assessed along with hemodynamic parameters. Results: The results showed that Group I had a faster onset of sensory block, a higher level of sensory blockade, and a more stable hemodynamic profile than Group II. The two-segment regression time and motor recovery time were significantly prolonged in the EVE group. Complications were minimal and comparable between the groups. Conclusion: The use of EVE in conjunction with CSE enhances the sensory block, reduces the required intrathecal dose of anesthetic, and provides better hemodynamic stability in patients undergoing lower limb orthopedic surgeries. EVE is a viable option for optimizing anesthetic management in such procedures.