Comparative study between sequential combined spinal epidural anesthesia versus epidural volume extension in lower limb surgery

Background This randomized, double-blind study was designed to compare between sequential combined spinal epidural anesthesia versus epidural volume extension in lower limb surgery as regards hemodynamics, sensory, and motor blocks. Methods In this randomized, double-blind, prospective study, 80 patients scheduled for lower limb surgery were divided into two groups: sequential combined spinal epidural (SCSE) group in which small doses of local anesthetic was injected in epidural space after low-dose spinal anesthesia and epidural volume extension (EVE) group in which 10 ml saline was injected in epidural space after low-dose spinal anesthesia. Hemodynamics, anesthesia readiness time, degree of motor block, time to regression of sensory block, and side effects were measured. Results Hemodynamic changes were insignificant. Anesthesia readiness time was significantly faster in EVE group. Motor block and sensory block were better in SCSE. Postoperative bupivacaine consumption was statistically insignificant between the two groups. Conclusion Both SCSE and EVE techniques can preserve hemodynamics after low-dose subarachnoid block and can be used in high-risk elderly patients undergoing orthopedic surgery.