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- W2081008586 abstract "The combined spinal-epidural (CSE) technique, currently popular in both obstetric and surgical anesthesia, allows injection of intrathecal drug and placement of an epidural catheter for subsequent use. This article will discuss several real and potential complications of CSE. Greater cephalad spread of spinal anesthesia occurs if the spinal is immediately followed by injection of local anesthetic or saline through the epidural catheter. Dural puncture facilitates movement of both morphine and local anesthetic across the meninges; however, the increased drug spread rarely causes clinical problems. If intrathecal local anesthetic has been administered, one must wait until the spinal block has regressed at least two dermatomes before testing the epidural to rule out unintended intrathecal catheter location. One must pay close attention to the patient's vital signs during catheter threading and patient positioning, especially if the patient sits during the block placement. Epidural catheters can pass easily through dural holes larger than 18 gauge but cannot be inserted through single 25 gauge holes. Spinal and epidural anesthetics fail no more frequently with the combined than with separate techniques. The incidence of unintended dural puncture is lower with the combined technique than with epidural anesthesia, and the overall incidence of headache is the same with the two techniques. Passing a spinal needle through an epidural needle does not lead to neuraxial deposition of metal particles. Damage to spinal needle tips or previously placed epidural catheters has not been reported. Despite these potential problems, the technique usually works quite well and is beneficial in many clinical circumstances." @default.
- W2081008586 created "2016-06-24" @default.
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- W2081008586 date "1997-07-01" @default.
- W2081008586 modified "2023-09-27" @default.
- W2081008586 title "Complications of the combined spinal-epidural technique" @default.
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- W2081008586 doi "https://doi.org/10.1016/s1084-208x(97)80030-4" @default.
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