Combined spinal and epidural Anaesthesia (CSEA) using separate interspace technique

Shreepathi Krishna Achar, Vinoda Venkata Rao

Research output: Contribution to journalArticle

Abstract

Background: The CSEA technique cannot be considered simply as an isolated spinal block followed by an isolated epidural block as combining the techniques may alter the characteristics of each block. This study was made to evaluate the clinical characteristics of CSEA. Methods: The study included 50 patients, undergoing elective lower limb and lower abdominal surgeries. An epidural catheter was secured at L 2-L 3 and subarachnoid block was performed at L 3 - L 4 interspace with 2ml of bupivacaine heavy 0.5%. Sensory blockade and haemodynamics were monitored at regular intervals. At 30 th minute epidural catheter was activated with 10 ml of bupivacaine 0.5% and monitoring was continued till the 60 th minute of the study. Results: Maximum levels of sensory blockade in spinal phase were T 10 - 24%; T 9 - 30%; T 8 - 24% and in epidural phase were T 6 - 26%; T 5 - 34%; T 4 - 26%. Average onset times were 12.56 and 11.20 minutes in spinal and epidural phases respectively. Segmental increase in epidural phase averaged 3.8 segments. Percentage population with significant (≥3 segments) increment was 78%. Most with a significant segmental increase had a lower level of sensory blockade in the spinal phase (i.e., T 11, T 10 & T 9). The rate of rise of sensory blockade showed an initial rapid phase followed by a sustenance phase. The magnitude of haemodynamic change from the baseline was computed from the "effect size of Cohen". Pulse rate, systolic, diastolic and mean blood pressure showed a positive effect, peaking twice, once in the spinal and another in the epidural phase. Conclusion: A preexisting subarachnoid block can be rapidly and significantly raised by an epidural injection of the drug, long after the spinal blockade had taken its full effect. In those who develop a lower level of sensory blockade in the spinal phase, the likelihood of significant rise in the epidural phase is high. The rate of rise of fixed sensory blockade in the epidural phase is rapid and predictable, especially in its initial part.

Original languageEnglish
Pages (from-to)69-75
Number of pages7
JournalSri Lankan Journal of Anaesthesiology
Volume19
Issue number2
Publication statusPublished - 01-12-2011
Externally publishedYes

Fingerprint

Epidural Anesthesia
Spinal Anesthesia
Bupivacaine
Catheters
Hemodynamics
Epidural Injections
Lower Extremity
Heart Rate
Blood Pressure
Pharmaceutical Preparations
Population

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine

Cite this

Achar, Shreepathi Krishna ; Rao, Vinoda Venkata. / Combined spinal and epidural Anaesthesia (CSEA) using separate interspace technique. In: Sri Lankan Journal of Anaesthesiology. 2011 ; Vol. 19, No. 2. pp. 69-75.
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abstract = "Background: The CSEA technique cannot be considered simply as an isolated spinal block followed by an isolated epidural block as combining the techniques may alter the characteristics of each block. This study was made to evaluate the clinical characteristics of CSEA. Methods: The study included 50 patients, undergoing elective lower limb and lower abdominal surgeries. An epidural catheter was secured at L 2-L 3 and subarachnoid block was performed at L 3 - L 4 interspace with 2ml of bupivacaine heavy 0.5{\%}. Sensory blockade and haemodynamics were monitored at regular intervals. At 30 th minute epidural catheter was activated with 10 ml of bupivacaine 0.5{\%} and monitoring was continued till the 60 th minute of the study. Results: Maximum levels of sensory blockade in spinal phase were T 10 - 24{\%}; T 9 - 30{\%}; T 8 - 24{\%} and in epidural phase were T 6 - 26{\%}; T 5 - 34{\%}; T 4 - 26{\%}. Average onset times were 12.56 and 11.20 minutes in spinal and epidural phases respectively. Segmental increase in epidural phase averaged 3.8 segments. Percentage population with significant (≥3 segments) increment was 78{\%}. Most with a significant segmental increase had a lower level of sensory blockade in the spinal phase (i.e., T 11, T 10 & T 9). The rate of rise of sensory blockade showed an initial rapid phase followed by a sustenance phase. The magnitude of haemodynamic change from the baseline was computed from the {"}effect size of Cohen{"}. Pulse rate, systolic, diastolic and mean blood pressure showed a positive effect, peaking twice, once in the spinal and another in the epidural phase. Conclusion: A preexisting subarachnoid block can be rapidly and significantly raised by an epidural injection of the drug, long after the spinal blockade had taken its full effect. In those who develop a lower level of sensory blockade in the spinal phase, the likelihood of significant rise in the epidural phase is high. The rate of rise of fixed sensory blockade in the epidural phase is rapid and predictable, especially in its initial part.",
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Combined spinal and epidural Anaesthesia (CSEA) using separate interspace technique. / Achar, Shreepathi Krishna; Rao, Vinoda Venkata.

In: Sri Lankan Journal of Anaesthesiology, Vol. 19, No. 2, 01.12.2011, p. 69-75.

Research output: Contribution to journalArticle

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