A Randomized Double-Blind Comparison of Double-Space Technique versus Single-Space Technique in Combined Spinal-Epidural Anesthesia for Cesarean Section

Abstract

Background: Combined spinal-epidural anesthesia (CSEA) can be performed as either a single-space technique or a double-space technique for Cesarean section. We performed a double-blind randomized controlled study to compare the effect of the double-space technique with that of the single-space technique on the sensory block level and side effects. Methods: Parturients undergoing elective Cesarean section under regional anesthesia were randomized to receive CSEA with either the double-space technique (double group, n = 20) or single-space technique (single group, n = 20). In the double group, an epidural catheter was inserted at the L1–2 interspace, and dural puncture was performed at the L3–4 interspace. In the single group, the procedure was performed at the L3–4 interspace using the needle-through-needle technique.Results: There were no differences in time to readiness or the intraoperative level of sensory block between the two groups. The postoperative sensory level was maintained higher in the double group (postoperative 1 h, P = 0.029; postoperative 6 h, P = 0.016). There was no difference between the two groups in side effects. The parturients’ satisfaction scores at 48 h postoperative were significantly different (9.5 in the double group vs. 8 in the single group, P = 0.004).Conclusions: We conclude that there were no differences in intraoperative variables between double -space technique and single space-technique for CSEA. However, double-space CSEA may be beneficial for postoperative pain control and parturients’ satisfaction scores of for Cesarean section.Trial registration: The study was registered at https://cris.nih.go.kr under the trial ID, KCT0002514, retrospectively registered. Date of registration: October 27, 2017.

An optimal epidural catheter placement site for post-cesarean section analgesia with double-space technique combined spinal–epidural anesthesia: a retrospective study

“…Although there was no difference in the analgesic effect depending on the catheter placement site, we observed a high occurrence of numbness and motor weakness at the T12-L1 interspace. Further, compared with the double-space technique, the single-space technique greatly affects the lower extremities since an epidural catheter is usually placed at L3-4 interspace, which has lower patient satisfaction [13].…”