The Present Status of Spinal (Subarachnoid) and Epidural (Peridural) Block

Abstract

N MANY hospitals, spinal (subarachnoid) I block is not administered for surgical or obstetric procedures for two principal reasons: (1) the complications, particularly headache and paralysis, are well known to the public; and (2) a lawsuit may result if a major complication occurs. Since headache from epidural block does not occur unless the dura is inadvertently punctured; since, as yet, the complications of epidural block and the term "epidural" are not known to the public; and, since relaxation following epidural block is comparable to that after spinal block, many anesthesiologists are now employing epidural anesthesia.The following questions, therefore, arise: Is epidural block as safe as spinal block? Which of the two technics is the more dependable? Is epidural block the answer to patient objections to spinal block?In our institution, both spinal and epi-dural blocks are administered to surgical and obstetric patients. The anesthesiologist sees the patient before surgery and tells him that he is to have either a spinal or epidural block, and the anesthesiologist sees the patient postoperatively. Because many of these patients return to the clinic for all medical needs, a comprehensive accumulation of data has been possible. METHOD OF STUDYData from a previous report on 11,574 cases of spinal block, from 1948 through 1964,l were combined with those from the present study by (1) preparing a tally sheet; (2) establishing a method of coding for the tally sheet; (3) transferring data from the anesthetic records to the tally sheets; (4) transferring tally sheet data to a standard 80-column punch-card; (5) verifying accuracy of transfer by a second operator; (6) reading the verified cards into a computer; and (7) storing the data on magnetic discs ready for processing.

Spinal Anesthesia Failure After Local Anesthetic Injection Into Cerebrospinal Fluid

“…The reported true incidence of spinal anesthesia failure varies largely. 1,2,4,11,12 Technical problems (ie, the inability to puncture the subarachnoid space) are the most common explanations both analyzed and reported in the medical literature. 4 We were able to identify only 28 detailed case reports with spinal anesthesia failure after injection of LA.…”

The Cardiorespiratory Effects of Thoracic Epidural Anaesthesia

“…The idea1 solution appears to be to use a technique whereby the sensory fibres are b10cked at the 1eve1 of the spinal cord, a resu1t which can be achieved by either spinal or epidura1 anaesthesia. The latter, thought to be safer (65,70), has been shown to be effective in terms of pain relief (12,14,25,83). However, its acceptabi1ity depends on c1earcut evidence that it is accompanied by litt1e or no upset of cardiovascular and respiratory function.…”

Subarachnoid Spinal Analgesia. Changing Patterns of Practice

“…While the publication of series with low complication rates (Moore et al, 1968;Noble and Murray, 1971) was a major influence on those who reported an increase in usage in 1976, it did not feature in any reply to the 1981 survey. The reasons given in 1981 for the increase in usage seem more related to individual situations in that the majority refer to a greater appreciation of the clinical value of the technique or to change in the type of patient dealt with.…”