Evaluation of Combined Spinal-Epidural Anesthesia Using Two Different Techniques

Joshi, Girish P.; McCarroll, S. M.

doi:10.1097/00132586-199412000-00036

Cited by 13 publications

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“…Similar results were obtained in other studies comparing SST with DST. [1011] Epidural catheterization was not possible in two cases of SST ( n =169) in a study by Takahashi et al . [12] There was no case with difficulty in advancement of the epidural catheter in SDT group.…”

Section: Discussionmentioning

confidence: 99%

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Paramedian epidural with midline spinal in the same intervertebral space: An alternative technique for combined spinal and epidural anaesthesia

Saigal

Wason

2013

Indian J Anaesth

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Background:Although different techniques have been developed for administering combined spinal epidural (CSE) anaesthesia, none can be described as an ideal one.Objectives:We performed a study to compare two popular CSE techniques: Double segment technique (DST) and single segment (needle through needle) technique (SST) with another alternative technique: Paramedian epidural and midline spinal in the same intervertebral space (single space dual needle technique: SDT).Methods:After institutional ethical clearance, 90 consenting patients undergoing elective lower limb orthopaedic surgery were allocated to receive CSE into one of the three groups (n=30 each): Group I: SST, Group II: SDT, Group III: DST using computerized randomization. The time for technique performance, surgical readiness, technical aspects of epidural and subarachnoid block (SAB) and morbidity were compared.Results:SDT is comparable with SST and DST in time for technique performance (13.42±2.848 min, 12.18±6.092 min, 11.63±3.243 min respectively; P=0.268), time to surgical readiness (18.28±3.624 min, 17.64±5.877 min, 16.87±3.137 min respectively; P=0.42) and incidence of technically perfect block (70%, 66.66%, 76.66%; respectively P=0.757). Use of paramedian route for epidural catheterization in SDT group decreases complications and facilitates catheter insertion. There was a significant number of cases with lack of dural puncture appreciation (SST=ten, none in SDT and DST; P=0.001) and delayed cerebrospinal fluid reflux (SST=five, none in SDT and DST; P=0.005) while performance of SAB in SST group. The incidence of nausea, vomiting, post-operative backache and headache was comparable between the three groups.Conclusion:SDT is an acceptable alternative to DST and SST.

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Section: Discussionmentioning

confidence: 99%

“…[1114] No significant difference in post-operative epidural catheter migration between SST and DST was noted by Casati et al . and Lyon et al .…”

Section: Discussionmentioning

confidence: 99%

Paramedian epidural with midline spinal in the same intervertebral space: An alternative technique for combined spinal and epidural anaesthesia

Saigal

Wason

2013

Indian J Anaesth

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“…yerleşimi, (32) oklüz-yonu, kırılması, (34) sızıntı yapması (17) veya kateterin hiç yerleştirilememesi (9,17,35) ya da normal çalışır görümündeki katetere rağmen, başarısızlık (9,17,26,35) olabileceğini bildiren çalışmamızdaki sonuçlara benzer bildirimlerin yanı sıra iğne ve setlerin geliştirilmesinin başarısızlığı düşüreceğini (2) öngören yayınlar bulunmaktadır.…”

Section: Discussionunclassified

“…(1)(2)(3)(4) Hasta güvenliği ve anestezi kalitesinde son yüzyılda büyük ilerlemelere rağmen, nöroaksiyel bloklarda başarısız-lık ve buna bağlı olarak anestezistin ciddi sorunlarla baş etmek zorunda kalması söz konusu olabilir. Başarısız ve yetersiz blok hem anestezist hem de hasta için kaygı verici olup rejyonal anestezinin avantajlarını, derin sedasyon veya genel anestezi nedeniyle daha fazla ilaç enjeksiyonu ya da yeni girişimlere bağlı komplikasyonlarla dezavantaja dönüştürebilir.…”

Section: Introductionunclassified

Failure of Neuraxial Blocks and Etiologic Factors

Özdemir¹,

Kayhan²

2011

J Turk Anaesth Int Care

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ÖZETAmaç: Anestezi, postoperatif analjezi ve ağrı tedavisi amacı ile kullanımları giderek artan nöroaksiyel bloklardaki gelişmelere karşın başarısızlık söz konusu olabilmektedir. Planlanan blok tekniğinin gerçekleştirilememesi, yetersiz ya da eksik kalması şeklinde tanımlanabilecek başarısızlık konusundaki veriler, başarısızlığın tanımı ve yöntem farklılıkları nedeniyle değişken olabilmektedir. Bu çalışmada nöroaksiyel bloklarda başarısızlık oranlarını ve nedensel ilişkilerini tespit edip sonraki girişimlere yol gösterici olmayı hedefledik.Gereç ve Yöntem: Araştırma kurulu onayı ile 1998-2008 yılları arasında, 18 yaş ve üzeri hastalarda cerrahi amaçla uygulanan 7.263 nöraksiyel blok incelendi. Genel anestezi eşliğinde yapılan 297 epidural blok değerlendirme dışı bırakılarak 6966 hastanın demografik ve özgeçmiş özellikleri, yandaş sorunları, yöntem ve uygulama özellikleri, başarı-sızlık kriterleri ve nedenleri, cerrahi özellikleri değerlendirildi. İstatistiksel değerlendirme için Chi-Square, Student-T ve Mann-Whitney U testleri kullanıldı. Anlamlı başarısızlık etkeni olarak bulunan parametrelerde lojistik regresyon analizi ile bağımsız risk faktörleri belirlendi.Bulgular: Hastaların %10,69'unda nöroaksiyel blok uygulanmış olup, tüm bloklarda başarısızlık hızı %5,4; spinal anestezi (SA)'de %3,9, epidural anestezi (EA)'de %10,9, kombine spinal epidural (KSE) blokta %6,4 tespit edilmiştir. Bağımsız risk etkenleri, blokların tümünde ilişki gücüne göre, paramediyan yaklaşım (p<0,001/OR 30,8), periferik damar hastalığı (p<0,001/OR 2,5), epidural blok (p<0,001/OR 2,6), cerrahi girişim süresi (p<0,001/OR 2,3), uzman deneyimi gereksinimi (p<0,001/OR 1,9), kronik obstrüktif akciğer hastalığı (p=0,014/OR 1,7), nörolojik hastalık (p<0,001/ OR 2,6) ve vücut ağırlığı (p=0,023/OR 1,0) olarak tespit edilmiştir.Sonuç: Sonuç olarak; dikkatli değerlendirme, girişime uygun yöntem seçilmesi, güçlük öngörüldüğünde erkenden uzman deneyimine başvurulması ve kayıtların düzenli tutulmasının başarısızlık oranını azaltıp hasta güvenliğini artıra-cağı kanısına varıldı.Anahtar kelimeler: Nöroaksiyel bloklar, spinal, epidural, kombine spinal epidural SUMMARY Failure of Neuraxial Blocks and Etiologic FactorsObjective: Neuraxial blocks are increasingly used for anesthesia, postoperative analgesia, and pain management. In spite of advancements in neuroaxial block procedures, difficulty or failure to obtain satisfactory block is still the main isue. Data on operational failure which can be defined as inability to achieve planned blockade technique, its inadequacy or deficiency, differ due to the variability in description of the criteria of failure, and also methodologic differences. In this study we aimed to determine the rates of failure and causal correlations in cases with neuraxial blocks as to guide future attempts.Material and Method: After the approval of Research Committee, records of 7263 patients aged ≥18 years who had received neuraxial blocks between 1998-2008 were examined. Patients (n=297) who were given epidural blocks under genera...

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“…CSE allows the advantages of spinal and epidural anaesthesia techniques without increasing the risk of complications. Thus, along with the rapid onset and reliability of spinal block, postoperative pain control can be provided by prolonging block duration via the epidural catheter (3)(4)(5)(6). In single-dose spinal anaesthesia in pregnant women, rapidly developing hypotension due to sympathetic blockade can be decreased by the combination of local anaesthetic agents and opioids (7,8).…”

mentioning

confidence: 99%

Comparison of Maternal and Neonatal Effects of Combined Spinal Epidural Anesthesia in the Sitting or Lateral Position During Elective Cesarean Section

Tan¹,

Günaydın²

2014

Turk J Anesth Reanim

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Objective:Our goal was to demonstrate which position would be hemodynamically and technically better by comparing the effects of combined spinal epidural (CSE) in the sitting or lateral decubitus position for elective cesarean deliveries on maternal and neonatal parameters and ephedrine requirement.Methods: Sixty parturients were randomly assigned into two groups to perform CSE in the sitting (Group I, n=30) or right lateral decubitus position (Group II, n=30) using hyperbaric 10 mg bupivacaine and 20 µg fentanyl. Mean arterial pressure (MAP), heart rate (HR), and characteristics of sensory and motor block were recorded from intrathecal drug administration until the end of surgery. Ephedrine and 1 st analgesic requirement, number of attempts to perform CSE, incidence of paresthesia during spinal needle insertion, and Apgar scores were recorded.Results: Ephedrine requirements and HR changes were similar in both groups. However, MAP values at 45 min in Group II were significantly less than in Group I. Maximum sensory block levels in Group II were significantly higher than in Group I. Despite similar motor block recovery times in both groups, regression times of sensory block and 1st analgesic requirement in Group II were significantly longer than in Group I. Incidence of paresthesia due to spinal needle (3.3% versus 20% in Groups I and II, respectively) and number of attempts to perform CSE (26.7% versus 60% in Groups I and II, respectively) were significantly higher in Group II. Apgar scores were similar in both groups. Conclusion:Performing CSE in the sitting position would be safer and easier because higher and earlier onset of sensory block, and a greater number attempts at epidural insertion and paresthesia develop to spinal needle insertion in the right lateral position.

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Evaluation of Combined Spinal-Epidural Anesthesia Using Two Different Techniques

Cited by 13 publications

References 0 publications

Paramedian epidural with midline spinal in the same intervertebral space: An alternative technique for combined spinal and epidural anaesthesia

Paramedian epidural with midline spinal in the same intervertebral space: An alternative technique for combined spinal and epidural anaesthesia

Failure of Neuraxial Blocks and Etiologic Factors

Comparison of Maternal and Neonatal Effects of Combined Spinal Epidural Anesthesia in the Sitting or Lateral Position During Elective Cesarean Section

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