Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-10T06:57:55.955Z Has data issue: false hasContentIssue false
  • English
  • Français

201 Combined spinal–epidurals for anaesthesia using a separate needle technique

Published online by Cambridge University Press:  23 December 2004

T. M. Cook
T. M. Cook
Affiliation:
Royal United Hospital, Combe Park, Bath, England
Get access

Abstract

Summary

Background and objective: Combined spinal–epidural (CSE) anaesthesia may be performed using separate needles or by passing the spinal needle through an epidural needle. The latter technique requires that subarachnoid block is performed before the epidural catheter is placed. This paper examines a series of 201 consecutive CSEs performed with a novel separate needle technique, designed to avoid potential and actual problems associated with the CSE technique.

Methods: The CSE technique involved placement of the spinal needle in the subarachnoid space, followed by replacement of the spinal needle stylet. The epidural catheter was then positioned separately before returning to the spinal needle and injecting the subarachnoid drug.

Results: The technique had a high technical success rate. Both needles were successfully placed in 200 (99.5%) cases. Spinal anaesthesia was successful in all cases. The epidural catheter was used in 179 cases and failure of the epidural occurred in 2 (1.1%) cases. Paraesthesia, inability to advance the epidural catheter or blood in the epidural catheter occurred in 31 (15.4%) and necessitated immediate replacement of the epidural catheter in 14 (7%) cases. Postoperatively, typical post-dural puncture headache was reported by one patient (0.5%) and mild backache by four (2%). There were no neurological complications.

Conclusions: This method of CSE anaesthesia can be associated with high success and low complication rates.

Keywords

Techniqueregional anaesthesiacombined spinal epidural
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 9 , September 2004 , pp. 679 - 683
Copyright
2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Meetings presented: European Society of Regional Anaesthesia meeting, Poole, UK, May 2003.

References

Herbstman CH, Jaffee JB, Tuman KJ, Newman LM. An in vivo evaluation of four spinal needles used for the combined spinal–epidural technique. Anesth Analg 1998; 86: 520–522.Google Scholar
Turner MA, Reifenberg NA. Combined spinal epidural analgesia. The single space double-barrel technique. Int J Obs Anaesth 1995; 4: 158–160.Google Scholar
Cook TM. A new combined spinal–epidural technique. Int J Obs Anaesth 1999; 8: 3–6.Google Scholar
Collis RE, Baxandall ML, Srikantharajah ID, Edge G, Kadim MY, Morgan BM. Combined spinal epidural (CSE) analgesia: technique, management, and outcome of 300 mothers. Int J Obs Anaesth 1994; 3: 75–81.Google Scholar
Rawal N. European trends in the use of combined spinal epidural technique – a 17 country survey. Reg Anesth 1996; 76: A319.Google Scholar
Lyons G, Macdonald R, Mikl B. Combined spinal–epidural anaesthesia for Caesarian section. Anaesthesia 1992; 47: 199–201.Google Scholar
Joshi GP, McCarroll SM. Evaluation of combined spinal–epidural anaesthesia using two different techniques. Anaesth Int Care 1995; 23: 600–604.Google Scholar
Westbrook JL, Donald F, Carrie LES. An evaluation of a combined spinal/epidural needle set utilising a 26-gauge pencil point spinal needle for Caesarian section. Anaesthesia 1992; 47: 990–992.Google Scholar
Simsa J. Use of 29-gauge spinal needles and a fixation device with the combined spinal epidural technique. Acta Anaesth Scand 1994; 38: 439–444.Google Scholar
Norris MC. Are combined spinal epidural catheters reliable. Int J Obs Anaesth 2000; 9: 3–6.Google Scholar
Poulakka R, Pitkanen MT, Rosenberg PH. Comparison of technical and block characteristics of different combined spinal and epidural anesthesia techniques. Reg Anesth Pain Med 2001; 26: 17–23.Google Scholar
Vandermeersch E. Combined spinal–epidural anaesthesia. Ballières Clin Anaesth 1993; 7: 691–708.Google Scholar
Carrie LES, O'Sullivan GM. Subarachnoid bupivacaine 0.5% for Caesarian section. Eur J Anaesthesiol 1984; 1: 275–283.Google Scholar
Roberts E, Brighouse D. Combined spinal–epidural anaesthesia for Caesarian section. Anaesthesia 1992; 47: 1006.Google Scholar
Rawal N, Van Zundert A, Holmstrom B, Crowhurst JA. Combined spinal–epidural technique. Reg Anesth 1997; 22: 406–423.Google Scholar
Horlocker TT, McGregor DG, Matsushige DK, Schroeder DR, Besse JA. A retrospective review of 4767 consecutive spinal anesthetics: central nervous system complications. Anesth Analg 1997; 84: 578–584.Google Scholar
Holloway J, Seed PT, O'Sullivan G, Reynolds F. Paraesthesiae and nerve damage following combined spinal epidural and spinal anaesthesia: a pilot study. Int J Obs Anaesth 2000; 9: 151–155.Google Scholar
Hoffmann VLH, Vercauteran MP, Buczkowski PW, Vanspringel GLJ. A new combined spinal epidural apparatus: measurement of the distance to the epidural and subarachnoid spaces. Anaesthesia 1997; 52: 350–355.Google Scholar
Levin A, Segal S, Datta S. Does combined spinal–epidural analgesia alter the incidence of paraesthesia during epidural catheter insertion? Anesth Analg 1998; 86: 445–451.
Casati A, D'Ambrosio A, De Negri P, Fanelli G, Tageriello V, Tarantino F. A clinical comparison between needle-through-needle and double segment techniques for combined spinal and epidural anesthesia. Reg Anesth Pain Med 1998; 23: 390–394.Google Scholar
Bahk J-H, Ko H. Damage to the conus medullaris following spinal anaesthesia. Anaesthesia 2001; 56: 813–814.Google Scholar
Reynolds F. Damage to the conus medullaris following spinal anaesthesia. Anaesthesia 2001; 56: 238–247.Google Scholar
Cook TM. Combined spinal–epidural techniques. Anaesthesia 2000; 55: 42–64.Google Scholar