Reversal of lidocaine with epinephrine epidural anesthesia using epidural saline washout

Background and Objectives: Prolonged motor and sensory block following epid ural anesthesia can be associated with extended postoperative care unit sta ys and patient dissatisfaction. Previous studies have demonstrated a more r apid motor recovery following the administration of epidural crystalloids i n patients who had received plain bupivacaine and lidocaine epidural anesth esia. However, epinephrine is commonly added to local anesthetics to improv e the quality and prolong the duration of the epidural block. The objective of this study was to determine the relationship of 0.9% NaCl epidural cath eter flush volume (i.e., washout) to the recovery of motor and sensory bloc k in patients undergoing 2% lidocaine with epinephrine epidural anesthesia. Methods: A prospective. randomized, double-blind study design was utilized. Thirty-three subjects scheduled for elective gynecologic or obstetrical su rgical procedures underwent epidural anesthesia using 2% lidocaine with epi nephrine (1:200,000). A T4 dermatome level of analgesia, determined by toot hpick prick, was maintained intraoperatively. Following surgery, subjects w ere randomized to 1 of 3 treatment groups. Group 1 (control, n = 11) receiv ed no epidural 0.9% NaCl (normal saline [NS]) postoperatively. Group 2 (15 mL NS X 1, n = 10) received an epidural bolus of 15 mL NS. Group 3 115 mL N S x 2, n = 12) received an epidural bolus of 15 mt NS postoperatively and a second 15-mL NS bolus 15 minutes later. Assessment of motor and sensory bl ock was performed at 15-minute intervals until complete motor and sensory r ecovery. Results: Times to partial and full motor and sensory recovery were signific antly faster in the epidural NS groups than in the control group. Full moto r recovery was more rapid in subjects receiving two 15-mL NS epidural NS bo luses (30 mL total) compared with those receiving a single 15-mL. NS bolus (108 +/- 9 min v 136 +/- 13 min) and significantly faster than control grou p subjects (153 +/- 14 min). Both NS X 1 and NS x 2 epidural bolus groups e xperienced significantly reduced times to complete sensory recovery when co mpared with the control group INS X 1 = 154 +/- 13 min, NS x 2 = 153 +/- 9 min, control 195 +/- 14 min). Conclusions: A more rapid recovery of motor and sensory block in patients u ndergoing 2% lidocaine with epinephrine epidural anesthesia can be achieved with the use of 30 mt NS epidural washout.