title: Combined spinal-epidural anesthesia with epidural volume extension causes a higher level of block than single-shot spinal anesthesia.
abstract: OBJECTIVE
  We evaluated the effects of epidural injection with levobupivacaine or serum physiologic, epidural volume extension (EVE), when using combined spinal-epidural anesthesia (CSEA) for cesarean delivery.
  
  
  METHODS
  One-hundred and thirty-eight patients with a full-term pregnancy of 37-42 weeks that were scheduled for cesarean delivery were included. Group 1 (n=48) received single-shot spinal anesthesia (SSS), group 2 (n=45) received CSEA-EVE with saline, group 3 received CSEA-EVE with levobupivacaine. The characteristics of motor and sensory block, the effects on maternal hemodynamic changes and the effects on the newborn were compared.
  
  
  RESULTS
  Time to reach maximum sensory block was significantly shorter in groups 3 than in group 1 and 2 (p<0.05). Two-segment regression time of sensory block was significantly shorter in group 1, whereas it was significantly longer in group 3 than in group 2 (p<0.05). Time to onset of motor block was significantly longer in group 1 than in groups 2 and 3 (p<0.05). Time to reach maximum motor block was significantly shorter in group 3 than in groups 1 and 2 (p<0.05). Time to recovery of motor block was significantly longer in group 3 than in groups 1 and 2 (p<0.05). The time to first analgesic was significantly longer in group 3 (p<0.05).
  
  
  CONCLUSIONS
  Sufficient and rapid motor and sensory block was achieved in all the patients in the present study; however, motor and sensory block had faster onset, lasted longer, and was of a higher level in groups 2 and 3; these effects were more pronounced in the group 3.
authors.affiliation: Medical Park Hospital, Department of Anesthesiology and Reanimation, Antalya, Turkey.
authors.forename: Canan
authors.initials: C
authors.lastname: Salman
authors.forename: Nurten
authors.initials: N
authors.lastname: Kayacan
authors.forename: Fatma
authors.initials: F
authors.lastname: Ertuğrul
authors.forename: Zekiye
authors.initials: Z
authors.lastname: Bıgat
authors.forename: Bilge
authors.initials: B
authors.lastname: Karslı
mesh_terms: D000293:Adolescent; D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D002585:Cesarean Section; D005260:Female; D006801:Humans; D009407:Nerve Block / Q000379:methods*; D011247:Pregnancy; D055815:Young Adult