title: Study of quality and extent of intrathecal bupivacaine block by extradural injection of bupivacaine or normal saline in combined spinal epidural technique.
abstract: OBJECTIVE
  The aim of the present study is to substantiate and compare the quality and extent of nerve block by using intrathecal bupivacaine or extradural bupivacaine alone and in combined spinal-epidural (CSE) technique using smaller dose of intrathecal bupivacaine and extradural injection of a smaller dose of bupivacaine or normal saline.
  
  
  METHODS
  A prospective study design was set up with 60 adult patients scheduled for vaginal and lower abdominal operation under CSE technique and single spinal or epidural technique.
  
  
  METHODS
  60 patients undergoing infra-umbilical surgery were divided into three groups (Group). Group A1 (control) 10 patients received 3 ml of intrathecal heavy bupivacaine. A2-10 patients received 16 ml isobaric bupivacaine extradurally Group B (n = 20) patients received 2 ml intrathecal heavy bupivacaine and 10 ml normal saline extradurally. Group C patients (n = 20) received 2 ml heavy bupivacaine intrathecally and 10 ml isobaric bupivacaine extradurally. A total duration of this study was 18 months. Duration of motor block, sensory block, analgesia, onset of sensory block and cephaloid extent of sensory block and side-effects noted among patients. Visual analog scale in the post-operative period was recorded.
  
  
  METHODS
  The results were analyzed statistically by applying analysis of variable, odds ratio and Chi-square test.
  
  
  RESULTS
  Patients were comparable regarding the onset time and height and duration of sensory block with a significant difference, though there was no difference in duration of motor block and analgesia. The side-effects in the control group are higher than the other two groups.
  
  
  CONCLUSIONS
  Quality of nerve block in combined technique using bupivacaine both intrathecally and extradurally is better and associated with lower side-effect compared with intrathecal heavy bupivacaine or extradural isobaric bupivacaine alone.
authors.affiliation: Department of Anaesthesiology, West Bengal Health Service, Howrah District Hospital, Bankura, India.
authors.forename: Sarmila
authors.initials: S
authors.lastname: Guha Banerjee
authors.affiliation: Department of Pathology, R.I.O. Medical College, Bankura, India.
authors.forename: Ujjwal
authors.initials: U
authors.lastname: Bandyopadhyay
authors.affiliation: Department of Gynecology and Obstetrics, West Bengal Health Service, Bisnupur Sub-Division Hospital, Bankura, India.
authors.forename: Pradyut Kumar
authors.initials: PK
authors.lastname: Pan
authors.affiliation: Department of Medicine, I.D and B.G Hospital, Kolkata, West Bengal, India.
authors.forename: Arijit
authors.initials: A
authors.lastname: Sinha
keywords: Bupivacaine; extradural normal saline; spinal-epidural technique