{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T17:10:06Z","timestamp":1785345006054,"version":"3.55.0"},"reference-count":41,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2017,9,11]],"date-time":"2017-09-11T00:00:00Z","timestamp":1505088000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    Epidural volume extension, a modification of combined spinal\u2013epidural anaesthesia, involves the epidural injection of saline in order to increase the spread of drugs given intrathecally. Results from individual studies have so far been contradictory and we aimed to gather the available evidence for this technique. We performed a systematic literature search for randomised, controlled trials comparing epidural volume extension after spinal injection with a control group without epidural injection in patients undergoing surgery. Conventional meta\u2010analyses, trial sequential analyses and meta\u2010regression were performed, with the Grading of Recommendations on Assessment, Development and Evaluation (\n                    <jats:styled-content style=\"fixed-case\">GRADE<\/jats:styled-content>\n                    ) approach used to express reliability of outcome estimates. We included 15 studies with 1177 participants. Meta\u2010analyses for the primary outcomes, such as maximum sensory height (6 studies, 274 participants, mean difference (MD) (95%CI) \u22120.59 (\u22121.24 to 0.07) dermatomes, low\u2010quality evidence) and hypotension (10 studies, 683 participants, risk ratio (95%CI) 0.84 (0.66\u20131.07), low\u2010quality evidence), did not differ significantly between the two treatment arms, but trial sequential analysis suggested insufficient evidence to be certain of these findings. Meta\u2010regression suggested a volume\u2010dependent effect, with higher volumes causing a higher spread of intrathecal drugs and a higher incidence of hypotension. A sub\u2010group analysis indicated a pronounced effect on motor block recovery time when a lower anaesthetic dose plus epidural volume extension was compared with a higher anaesthetic dose without epidural volume extension, the MD (95%CI) being \u221266.75 (\u221276.0 to \u221257.5) min, with trial sequential analysis suggesting the evidence was sufficient to draw this conclusion. In trials using the same anaesthetic mixture in the epidural volume extension and the control groups, motor block recovery time did not differ between groups, with a MD (95%CI) of \u22121.06 (\u22125.48 to 3.36) min, although trial sequential analysis suggested insufficient evidence. In summary, there is not enough evidence to draw definite conclusions on the effect of epidural volume extension. The quality of the current evidence is low for both efficacy (maximum sensory height) and safety (hypotension). However, there may be a significantly shorter motor block recovery time when different anaesthetic mixtures are used in epidural volume extension and control groups; this warrants further investigation.\n                  <\/jats:p>","DOI":"10.1111\/anae.14033","type":"journal-article","created":{"date-parts":[[2017,9,11]],"date-time":"2017-09-11T03:02:42Z","timestamp":1505098962000},"page":"1398-1411","source":"Crossref","is-referenced-by-count":17,"title":["Effects of epidural volume extension by saline injection on the efficacy and safety of intrathecal local anaesthetics: systematic review with meta\u2010analysis, meta\u2010regression and trial sequential analysis"],"prefix":"10.1111","volume":"72","author":[{"given":"M.","family":"Heesen","sequence":"first","affiliation":[{"name":"Department of Anaesthesia Kantonsspital Baden Baden Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Weibel","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Critical Care University Hospital W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Klimek","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia Erasmus University Medical Centre Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Rossaint","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia University Hospital RWTH Aachen Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. 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