Combined continuous spinal‐epidural anaesthesia with a single interspace, double‐catheter technique

Abstract

A double catheter, single interspace combined spinal-epidural anaesthetic was performed in 12 ASA grade 3 patients. The technique failed in one patient in whom the intrathecal catheter could not be inserted satisfactorily. In another patient, the epidural catheter was accidentally placed intrathecally. The maximum height of the block obtained with hyperbaric lignocaine or bupivacaine was below T,, in all patients and there were no adverse cardiovascular changes. As opposed to a classical combined spinal-epidural block, this technique is most suitable for very debilitated patients. The advantages are the ability to titrate the intrathecal dose of the local anaesthetic to achieve the desired dermatomal level and to test the correct position of the epidural catheter before injecting drugs intrathecally.

Combined Spinal and Epidural Anaesthesia in Elderly Patients

“…An alternative is to produce a limited spinal block, which can be adjusted to the desired level and intensity by subsequent epidural top‐ups. Finally, both parts of the combined spinal and epidural block may be fully employed, ensuring a reliable but perhaps unnecessarily intense and high block 1 …”

“…Combined spinal‐epidural (CSE) block has gained popularity in the past decade. The major benefit of the CSE technique is that the intense sensory and motor block obtained with an intrathecal local anaesthetic injection may be supplemented preoperatively or extended into the postoperative period by further injection of the drug through an epidural catheter 1 …”

“…Because extradural and spinal blocks have advantages when given separately, it has been suggested that combining the two techniques may be more beneficial and without increasing the incidence of complications 2 . Investigators have demonstrated that the CSE technique in ASA class III patients appears promising 1 …”

Study -“Comparative Study of Combined Spinal Epidural Versus Epidural Anaesthesia in Lower Limb Surgeries And Lower Abdominal Surgeries ”

“…Clearly, such errors could be life-threatening if not detectedearly. At the present time due to concerns about the risk of inadvertent epidural injection oflocal anesthetic through the subarachnoid, rather than through the epidural catheter, thedual catheter technique is rarely used 58,59 .…”

Combined Spinal Epidural Anesthesia and Analgesia

“…Clearly, such errors could be life-threatening if not detected early. At the present time due to concerns about the risk of inadvertent epidural injection of local anesthetic through the subarachnoid, rather than through the epidural catheter, the dual catheter technique is rarely used (Dahl et al, 1990;Vercauteren et al, 1993).…”