Block-dependent sedation during epidural anaesthesia is associated with delayed brainstem conduction

Abstract

Background: Neuraxial anaesthesia produces a sedative and anaesthetic-sparing effect. Recent evidence suggests that spinal cord anaesthesia modifies reticulo-thalamo-cortical arousal by decreasing afferent sensory transmission. We hypothesized that epidural anaesthesia produces sensory deafferentation-dependent sedation that is associated with impairment of brainstem transmission. We used brainstem auditory evoked potentials (BAEP) to evaluate reticular function in 11 volunteers.

Methods: Epidural anaesthesia was induced with 2-chloroprocaine 2%. Haemodynamic and respiratory responses, sensory block level, sedation depth and BAEP were assessed throughout induction and resolution of epidural anaesthesia. Sedation was evaluated using verbal rating score (VRS), observer's assessment alertness/sedation (OAA/S) score, and bispectral index score (BIS). Prediction probability (PK) was used to associate sensory block with sedation, as well as BIS with other sedation measures. Spearman's rank order correlation was used to associate block level and sedation with the absolute and interpeak BAEP latencies.

Results: Sensory block level significantly predicted VRS (PK=0.747), OAA/S score (PK=0.748) and BIS. BIS predicted VRS and OAA/S score (PK=0.728). The latency of wave III of BAEP significantly correlated with sedation level (rho=0.335, P<0.01) and sensory block (rho=0.394, P<0.01). The other BAEP parameters did not change during epidural anaesthesia. Haemodynamic and respiratory responses remained stable throughout the study.

Conclusions: Sedation during epidural anaesthesia depends on sensory block level and is associated with detectable block-dependent alterations in the brainstem auditory evoked responses. Sensory deafferentation may reduce CNS alertness through mechanisms related to brainstem neural activity.

Fig. 1.

Level of sedation, expressed by verbal rating sore (VRS, upper graph), and bispectral index (BIS, lower graph), as a function of the sensory block. The latter was categorized in 5-dermotome groups. Data are presented as means with 95% confidence intervals.

Fig. 2.

Latencies of I, III, and V brainstem auditory evoked potentials (BAEP) for each volunteer at baseline (No Block) and maximum block extension (Maximum Block) during the trial. If “Maximum Block” was maintained for more than one assessment, the latency data were averaged within the volunteers. Pseudo-paired t-test showed a significant increase only in the latency of wave III (^*P = 0.015).