A prospective randomized study to evaluate the effect of epidural volume extension with normal saline in combined spinal epidural anesthesia for lower limb surgeries using intrathecal hyperbaric levobupivacaine

Background: Combined spinal epidural anesthesia (CSEA) offers rapid onset and effective postoperative analgesia for lower limb surgeries. Epidural volume extension (EVE), achieved by epidural saline injection following intrathecal administration, influences the cephalad spread of local anesthetic. This study examined the effect of EVE with normal saline on sensory and motor block characteristics following intrathecal hyperbaric levobupivacaine.Methods: A total of 100 American Society of Anesthesiologists I–II patients aged 18–60 years were assigned to two groups. Group A received 2.5 ml of 0.5% hyperbaric levobupivacaine intrathecally, while Group B received the same dose followed by EVE with 10 ml of normal saline. Sensory and motor block onset, peak block height, regression characteristics, and epidural supplementation requirement were compared.Results: A peak sensory block height of T10 was achieved in Group A (42%), whereas T8 (46%) was achieved in Group B (P = 0.003). Sensory and motor block onset was significantly faster in Group B (P < 0.001). However, the motor block was longer in Group A (219.30 ± 22.20 min) than in Group B (206.20 ± 22.87 min; P = 0.005). Epidural top-up was numerically more frequent in Group B (18%) compared with Group A (6%), though this difference did not achieve statistical significance (P = 0.08). Adequate intraoperative anesthesia was achieved in all patients with timely epidural supplementation when required.Conclusions: EVE with normal saline in CSEA using intrathecal hyperbaric levobupivacaine results in faster onset and greater cephalad sensory blockade with comparable hemodynamic effects; however, it may be associated with earlier block regression in longer surgical procedures.