Chapter 7 - Combined spinal–epidural anesthesia and continuous spinal anesthesia

Summary

Neuraxial analgesia techniques are commonly performed to relieve pain during labor and to provide analgesia during cesarean section. When combined spinal-epidural (CSE) is used for labor analgesia it provides a faster onset with minimal motor block. This chapter describes the history and use of CSE techniques in laboring patients and for cesarean section. It discusses the advantages and disadvantages of these techniques compared to traditional spinal and epidural techniques. The chapter outlines the use of continuous spinal anesthesia (CSA) in obstetric patients. The catheter appears to be at least as effective as with the epidural technique; however, CSE has a higher rate of complications (e.g. nerve damage, infection) and side effects (e.g. pruritus, fetal heart rate (FHR) abnormalities) compared to epidural analgesia. The theoretical advantages of hemodynamic stability and prolonged block can be easily achieved with other techniques such as CSE at much lower complication rates.