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• W2050181893 abstract "I read with interest the paper evaluating a new combined spinal epidural locking needle device (Stocks et al. Anaesthesia 2000; 55: 1185–8), and wish to add to the discussion as to the possible causes of the (low) rate of failure of technique. The authors' previous work has shown that the injection of 2.5 mg of bupivacaine with 5 µg of fentanyl is greater than three times the ED50 for bupivacaine to provide analgesia in the first stage of labour [1]. This implies that failure of the CSE technique is likely to be due to failure to deliver this combination of drugs intrathecally. As outlined, one possible cause is movement of the spinal needle after successful dural puncture [2, 3]. An additional cause may be the misbelief that the spinal needle has punctured the dura, when in fact the side hole remains partially or wholly in the extradural space. The authors' figures show that in the CSEcure® group, no dural click could be identified in over 15% of cases whereas, following stylet removal, the appearance of a clear colourless fluid at the hub of the needle occurred in 98% of this group. If a loss of resistance to saline technique has been used, the extradural space will contain saline, and it may be that this fluid gives the appearance of CSF, and therefore the false appearance of successful dural puncture. In cases where heavy bupivacaine has been used for the spinal component of the CSE technique to provide analgesia for Caesarean section, a mixing of the solutions is directly visible as a result of the differing optical densities of the two solutions. However, this appearance is not characteristic for the presence of CSF in the needle hub, as the mixing of heavy bupivacaine with saline gives an identical effect. Thus the appearance of saline at the hub of the spinal needle after a loss of resistance to saline technique may give the impression of dural puncture, and so may contribute to the failure rate of the CSE technique for analgesia for both Caesarean section and labour." @default.
• W2050181893 created "2016-06-24" @default.
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• W2050181893 date "2001-05-02" @default.
• W2050181893 modified "2023-09-25" @default.
• W2050181893 title "The combined spinal-epidural technique for the provision of analgesia in obstetric anaesthesia" @default.
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• W2050181893 doi "https://doi.org/10.1046/j.1365-2044.2001.02047-26.x" @default.
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