Combined spinal and epidural anesthesia

The combined spinal and epidural anesthesia ( English Combined spinal and epidural anesthesia , CSE ) is a special method in anesthesia that combines the procedures of spinal anesthesia and epidural anesthesia (syn. Epidural anesthesia). This neuraxial is regional anesthesia causes. The CSE is used in particular in the obstetrical and orthopedic field. This principle of combined anesthesia was first used in 1937 by the US surgeon Angelo Luigi Soresi (1877–1951). Soresi was also the technique of hanging drop ( hanging drop technique particularly described) for locating the lumbar epidural space.

Possibilities and limitations

The CSE combines the advantages of spinal anesthesia (quick onset of action, good motor blockade) with the advantages of epidural anesthesia (possibility of re-injection via the lying peridural catheter, thus good postoperative pain relief ). A disadvantage is the inability to determine the correct position of the catheter by means of a test dose, since a possible incorrect position of the catheter is covered by the spinal anesthesia. The contraindications and side effects correspond to the two individual procedures.

execution

With the peridural cannula (e.g. according to Tuohy ), punctures are made in the usual technique ( loss of resistance , see there) at the level of the lumbar vertebrae L2 / 3 or L3 / 4 and the peridural space is sought. A thin spinal needle is inserted through the cannula, with which the subarachnoid space is punctured and the spinal anesthesia is carried out using a local anesthetic and possibly an opioid . This is then removed again and an epidural catheter is inserted and fixed in the epidural space. This can then be used to inject repeatedly as required.

literature

• Danilo Jankovic: Regional blockades and infiltration therapy. Textbook and atlas. Pp. 355-358. Abw Wissenschaftsverlag; 3rd edition 2003. ISBN 3-936072-16-7 .
• Jochen Schulte am Esch: anesthesia, intensive medicine, emergency medicine, pain therapy . Stuttgart: Thieme, 3rd edition, 2007. ISBN 3-13-119083-3
• Thomas Standl: Combined spinal epidural anesthesia (CSE) for pain therapy. Anesthesiology Intensivmed Emergency Med Schmerzther 2007; 42: 342-349
• Soresi AL: Episubdural Anesthesia. Anesth Analg 1937; 306-310

Individual evidence

1. ↑ Neruda, B .; Schmitz ‐ Franken, A .: Angelo Luigi Soresi (1877–1951), Inaugurator of Combined Spinal Epidural Anesthesia (CSE) and the Hanging Drop Technique. Regional Anesthesia & Pain M Medicine: September / October (2008) Volume 33 Issue 5

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