How can we turn the selectivity of an anesthetic agent toward the sensory without the motor fibers?
Also perfoming a spinal block in a combination with epidural anesthesia by choosing lower concentrations of bupivacain for a stable and long-lasting sensory block will be useful.
These two entities cannot be separated 100%.
The question is if we really need to bother so much. Epidurals are done in a wide range of procedures, mostly for analgesic purposes. And they are not left in place more than three days. In this time frame the patient is not necessarily supposed to walk, unless for some fancy research or reasons. We remember that some years ago there was a big fuss about “walking epidurals”. Do we hear anything really serious about that now? So, yes, lower concentration and higher volume is the common sense answer. The real concern should be the cardio-vascular repercussions in my opinion. The rest is open to any other comments.
In animals expecially horses is very critical to avoid the motor block whan we do standin sedations, for example in horse in the field. The use of lower concentrations of bupivacaine (0.125%) usually works very well. Of course you should consider that generally lowering the concentration means also lowering the dose of the LA and thus the potency and duration of the block. The combination with oppioids and/or alpha 2 agonists often help to ensure a more potent sensory block without interfering with the motor function.
Use low concentrations of local anaesthetics, add sufentanil and titrate the volum of anesthetic solution to obtain the required differential block
Agree with Edomer Tassonyi, the combination of a lipophilic narcotics (fentanyl/sufentanil) and low concentration local anesthetics (0.0625% bupivacaine or equipotent) can provide excellent analgesic effect with minor motor block.
I think that`s only possible in spinal anesthesia and not epidural anesthesia. In spinal anesthesia you can make a selective spinal block (dorsal root) by changing the baricity of the local anesthetic
Agree with Dr. Tassonyi and Dr. Wong about MINOR but not without motor block!
I Agree with Chung-Hang Wong . I use ussually bupivacaine 0,0625 plus fentanyl as epidural analgesia in ambulatory patients without any adverse effects.
Lower concentration of Bupivicaine .0625 plus fentanyl, 2 mcg/ml at high volumes of 10-15 ml per hour following a good boils dose of the above mixture of 10-15 ml to establish a level.
The aim is lowering the concentration of local anesthetic . You may use bupicacaine 0,625% or ropivacaine 2 % and add opioid such as fentanyl or sulfentanyl as an adjuvant.
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