Research Article Effect of Normal Saline Bicarbonate on Reversing Epidural Anesthesia Either with Bupivacaine Or Bupivacaine and Nalbuphine in Patients Undergoing Orthopedic Surgery Josef Attia, Ahamed Mohamed, and Yaser Bader Departments of Anesthesiology and ICU, Faculty of Medicine, Al-Minia University, Minia 61111, Egypt Correspondence should be addressed to Josef Attia; josefzekry2@yahoo.com Received 27 September 2014; Revised 7 February 2015; Accepted 16 February 2015 Academic Editor: Young-Chang P. Arai Copyright © 2015 Josef Attia et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Orthopedic procedures are among the commonest surgeries in the elderly. On the other hand, those patients have many risk factors suitable for development of postoperative complication due to prolonged postoperative recumbent that decrease by using anesthesia technique allowed early ambulation as far as possible. Aim of the Work. e aim of this study was to evaluate whether washout of the local anesthesia with 0.9% normal saline with bicarbonate through the epidural catheter could provide early ambulation throughout the faster recovery of the motor block. Patient and Methods. Sixty adult patients were included in this study and divided into three groups. In group I, epidural injection of bupivacaine was carried out without wash (control group). In group II, epidural injection of bupivacaine was followed by wash. In group III, epidural injection of both bupivacaine and nalbuphine was followed by wash. Results. ey were significantly faster in both group II and group III as compared with group I. In group I, sensory recovery was insignificantly faster than the motor recovery. In group II motor recovery was significantly faster than sensory recovery. In group III motor recovery was significantly faster than the sensory recovery. Conclusions. ese results suggested that early ambulation with an adequate postoperative analgesia was reported in patient receiving epidural injection of both bupivacaine and nalbuphine. 1. Introduction Epidural analgesia and anesthesia were proved to be an excellent method of anesthesia in patients undergoing lower limb orthopedic operations, especially in patient with high risk to develop postoperative complication either from delay recovery of motor function or from use of large dose of nar- cotics IM or IV to achieve adequate sensory block [1]. Wash of epidural catheter with normal saline with or without NaHCO 3 aims to achieve early motor recovery in a trial to avoid rapid sensory recovery as rapid motor recovery aſter wash of epidural catheter, nalbuphine was added as narcotic analgesic, and especially nalbuphine hydrochloride exhibits a ceiling effect in which the increase in the dose greater than 30 mg does not produce further respiratory depression in the absence of other CNS active medications affecting respiration. In addition, prolonged postoperative sensory and motor block following neuraxial blocks (spinal or epidural block) aſter short surgical procedures is a major disadvantage of this technique [2]. Our study planned to use nalbuphine with local anesthesia. As we worried about wash of epidural catheter with saline solution that results in faster return of the pain to the patient postoperatively, we aimed to study if adding nalbuphine to the local anesthetic agents can preserve the analgesic effect even aſter wash of local anesthesia. On the other hand, using narcotic with epidural anesthesia (IV or IM injected) requires large dose that may be associated with systemic complication; this disadvantage is minimized by injection of narcotics in epidural catheter. On the other hand, epidural injection of narcotic may be associated with complication, but this side effect is uncommon and occur with nalbuphine due to its ceiling effect, also using NSAIDs may not be suitable in elderly patient to avoid renal complication. Delay in the motor function in the major orthopedic surgery carries the risk of DVT development so epidural analgesia allows early Hindawi Publishing Corporation Advances in Anesthesiology Volume 2015, Article ID 509710, 7 pages http://dx.doi.org/10.1155/2015/509710