Combined spinal and epidural anaesthesia

The combined spinal and epidural anesthesia ( spinal and epidural anesthesia combined engl., CSE ) is a special method in anesthesia, which combines the methods of spinal anesthesia and epidural anesthesia ( epidural syn. ). As a result neuraxial anesthesia is effected. The CSE is especially used in obstetric and orthopedic surgery. This principle of combined anesthesia was first applied in 1937 by the U.S. surgeon Angelo Luigi Soresi ( 1877-1951 ). Soresi it was he who described the technique of hanging drop ( hanging drop technique ) for finding particular the lumbar epidural space.

Opportunities and constraints

The CSE combines the advantages of spinal anesthesia (rapid onset of action, good motor blockade ) with the advantages of epidural anesthesia (possibility of re-injection through the epidural catheter lying, therefore good postoperative pain control ). A disadvantage is the inability to determine the correct position of the catheter by a test dose because any wrong position of the catheter is covered by the spinal anesthesia. The contra-indications and side effects corresponding to the two individual methods.

Implementation

With the Periduralkanüle (eg after Tuohy ) is L2 / 3 or L3 / 4 punctured in the usual technique ( Loss -of- Resistance, qv) in the amount of lumbar and visited the epidural space. Via the indwelling cannula a thin spinal needle is introduced, with the dots of the subarachnoid space by means of spinal and topical anesthetic, and may be carried out an opioid. This is then removed and inserted and fixed in an epidural catheter in the epidural space. On this can be injected repeatedly as needed.