Combined spinal and epidural anaesthesia

Combined Spinal and Epidural Anaesthesia (CSEA) is a form of regional anesthesia that combines the benefits of both spinal anesthesia and epidural anesthesia. This technique is widely used in various surgical procedures, particularly in obstetrics for labor and delivery, due to its rapid onset and the ability to prolong anesthesia as needed. CSEA offers the rapid onset of anesthesia provided by spinal anesthesia with the flexibility and extended duration of an epidural block.

Indications

CSEA is primarily indicated for procedures requiring significant pain relief at the lower part of the body. It is commonly used in:

• Obstetrics, especially for labor and cesarean sections
• Lower abdominal surgeries
• Lower limb surgeries
• Certain urological and orthopedic procedures

Technique

The CSEA technique involves the sequential or simultaneous administration of drugs into the epidural and intrathecal spaces. The procedure is performed with the patient in either a sitting or lateral decubitus position. After aseptic preparation, a needle is inserted into the epidural space using the loss of resistance technique. A smaller, longer spinal needle is then passed through the epidural needle into the subarachnoid space, where a small dose of local anesthetic and/or opioid is injected. The spinal needle is withdrawn, and an epidural catheter is threaded through the epidural needle into the epidural space for continuous drug administration.

Advantages

• Rapid Onset: The spinal component provides a quick onset of anesthesia.
• Adjustable Duration: The epidural component allows for the extension of anesthesia as needed.
• Flexibility: The epidural catheter can be used to adjust the level and intensity of anesthesia.
• Reduced Drug Dosage: Lower doses of anesthetics can be used, reducing the potential for side effects.

Disadvantages

• Technical Complexity: The procedure is more complex than either spinal or epidural anesthesia alone.
• Risk of Hypotension: As with other regional techniques, there is a risk of hypotension.
• Potential for Dural Puncture: There is a risk of accidental dural puncture with the epidural needle.

Complications

Complications are rare but can include:

• Dural puncture headache
• Nausea and vomiting
• Hypotension
• Nerve damage
• Infection

Conclusion

Combined Spinal and Epidural Anaesthesia offers a versatile and effective method for providing anesthesia and analgesia in a variety of surgical and obstetric procedures. Its benefits of rapid onset and adjustable duration make it a valuable tool in the anesthesiologist's repertoire. However, the technique requires skill and experience to minimize the risks and manage potential complications.