COMBINED SPINAL EPIDURAL-ANESTHESIA

Although the idea of combining the advantages of epidural and spinal anaesthesia is not new, widespread application has only been possible since the recent introduction of high quality long spinal needles of extremely small diameter. However, for the original double interspace technique described by Brownridge (1979) no special material is needed and the epidural catheter can be introduced before the spinal anaesthetic is injected. For the modern single segment method, special double lumen epidural needles are available that also allow the insertion of the epidural catheter before the actual injection of the spinal anaesthetic. The opposite happens during the needle through the Tuohy needle technique. A small long spinal needle is introduced through an ordinary epidural needle, and the spinal injection precedes the insertion of the epidural catheter. There still is some controversy on the optimum length, diameter and shape of the bevel of the spinal needle. Adaptations have been made to the epidural needle for its use in CSE anaesthesia. The literature documents the use of CSE anaesthesia in an impressive variety of surgical interventions, but caesarean section seems to have become a favourite indication. A meticulous technique, using carefully selected materials, achieves a degree of flexibility and effectiveness unobtainable with either method alone. © 1993 Baillière Tindall.