Combined spinal-epidural anesthesia - Revision history

Brooke.Gangwish at 22:15, 1 October 2022

2022-10-01T22:15:59Z

← Older revision		Revision as of 15:15, 1 October 2022
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	'''Combined spinal-epidural''' (CSE) anesthesia is a neuraxial technique that offers benefits of both spinal and epidural anesthesia and analgesia. The CSE technique involves a subarachnoid injection followed by the placement of a catheter in the epidural space for administration of epidural medications. This permits rapid-onset spinal analgesia, with access for supplementing insufficient subarachnoid anesthesia or prolonging anesthesia and analgesia via the epidural catheter<ref>{{Cite book\|url=https://www.worldcat.org/oclc/70051351\|title=Textbook of regional anesthesia and acute pain management\|date=2007\|publisher=McGraw-Hill, Medical Pub. Division\|others=Admir Hadzic, New York School of Regional Anesthesia\|isbn=0-07-144906-X\|location=New York\|oclc=70051351}}</ref>. Though an ongoing debate, many argue that CSE is associated with lower failure rates and fewer adverse events than spinal or epidural anesthesia<ref name=":0">{{Cite web\|title=Combined Spinal Epidural (CSE)\|url=https://www.asra.com/news-publications/asra-updates/blog-landing/legacy-b-blog-posts/2019/08/07/combined-spinal-epidural-(cse)\|access-date=2022-09-26\|website=The American Society of Regional Anesthesia and Pain Medicine (ASRA)\|language=en}}</ref>. {{Infobox surgical procedure		'''Combined spinal-epidural''' (CSE) anesthesia is a neuraxial technique that offers benefits of both spinal and epidural anesthesia and analgesia. The CSE technique involves a subarachnoid injection followed by the placement of a catheter in the epidural space for administration of epidural medications. This permits rapid-onset spinal analgesia, with access for supplementing insufficient subarachnoid anesthesia or prolonging anesthesia and analgesia via the epidural catheter<ref name=":1">{{Cite book\|url=https://www.worldcat.org/oclc/70051351\|title=Textbook of regional anesthesia and acute pain management\|date=2007\|publisher=McGraw-Hill, Medical Pub. Division\|others=Admir Hadzic, New York School of Regional Anesthesia\|isbn=0-07-144906-X\|location=New York\|oclc=70051351}}</ref>. Though an ongoing debate, many argue that CSE is associated with lower failure rates and fewer adverse events than spinal or epidural anesthesia<ref name=":0">{{Cite web\|title=Combined Spinal Epidural (CSE)\|url=https://www.asra.com/news-publications/asra-updates/blog-landing/legacy-b-blog-posts/2019/08/07/combined-spinal-epidural-(cse)\|access-date=2022-09-26\|website=The American Society of Regional Anesthesia and Pain Medicine (ASRA)\|language=en}}</ref>. {{Infobox surgical procedure
	\| anesthesia_type = Regional		\| anesthesia_type = Regional
	\| airway = None		\| airway = None
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	*Inability of patient to remain still for injection (risk of neurologic injury)		*Inability of patient to remain still for injection (risk of neurologic injury)
	*Increased intracranial pressure (risk of brainstem herniation)		*Increased intracranial pressure (risk of brainstem herniation)
			Relative contraindications

	Relative contraindications		Relative contraindications
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	===CSE vs. Epidural Anesthesia===		===CSE vs. Epidural Anesthesia===
			The CSE technique provides more rapid onset analgesia and establishes surgical anesthesia 15-20 minutes faster than epidural anesthesia. CSE is also associated with lower failure rates and fewer adverse events<ref name=":1" />. A lower incidence of accidental intravascular epidural catheters, inadequate epidural analgesia, and catheter replacements has been reported in patients who received CSE<ref>{{Cite web\|date=2018-09-20\|title=Combined Spinal-Epidural Anesthesia\|url=https://www.nysora.com/topics/regional-anesthesia-for-specific-surgical-procedures/abdomen/combined-spinal-epidural-anesthesia/\|access-date=2022-10-01\|website=NYSORA\|language=en}}</ref>. Higher success rates may be due to confirmation of epidural space via CSF return with spinal needle. More complete sensory blockade with improved sacral spread has also been reported with CSE, though local anesthetic flux through the dural puncture site also varies with choice of spinal needle <ref name=":0" />.

	===CSE vs. Spinal Anesthesia===		===CSE vs. Spinal Anesthesia===

Brooke.Gangwish at 04:07, 30 September 2022

2022-09-30T04:07:57Z

← Older revision		Revision as of 21:07, 29 September 2022
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	Combined spinal-epidural (CSE) anesthesia is a neuraxial technique that offers benefits of both spinal and epidural anesthesia and analgesia. The CSE technique involves a subarachnoid injection followed by the placement of a catheter in the epidural space for administration of epidural medications. This permits rapid-onset spinal analgesia, with access for supplementing insufficient subarachnoid anesthesia or prolonging anesthesia and analgesia via the epidural catheter<ref>{{Cite book\|url=https://www.worldcat.org/oclc/70051351\|title=Textbook of regional anesthesia and acute pain management\|date=2007\|publisher=McGraw-Hill, Medical Pub. Division\|others=Admir Hadzic, New York School of Regional Anesthesia\|isbn=0-07-144906-X\|location=New York\|oclc=70051351}}</ref>. Though an ongoing debate, many argue that CSE is associated with lower failure rates and fewer adverse events than spinal or epidural anesthesia<ref name=":0">{{Cite web\|title=Combined Spinal Epidural (CSE)\|url=https://www.asra.com/news-publications/asra-updates/blog-landing/legacy-b-blog-posts/2019/08/07/combined-spinal-epidural-(cse)\|access-date=2022-09-26\|website=The American Society of Regional Anesthesia and Pain Medicine (ASRA)\|language=en}}</ref>. {{Infobox surgical procedure		'''Combined spinal-epidural''' (CSE) anesthesia is a neuraxial technique that offers benefits of both spinal and epidural anesthesia and analgesia. The CSE technique involves a subarachnoid injection followed by the placement of a catheter in the epidural space for administration of epidural medications. This permits rapid-onset spinal analgesia, with access for supplementing insufficient subarachnoid anesthesia or prolonging anesthesia and analgesia via the epidural catheter<ref>{{Cite book\|url=https://www.worldcat.org/oclc/70051351\|title=Textbook of regional anesthesia and acute pain management\|date=2007\|publisher=McGraw-Hill, Medical Pub. Division\|others=Admir Hadzic, New York School of Regional Anesthesia\|isbn=0-07-144906-X\|location=New York\|oclc=70051351}}</ref>. Though an ongoing debate, many argue that CSE is associated with lower failure rates and fewer adverse events than spinal or epidural anesthesia<ref name=":0">{{Cite web\|title=Combined Spinal Epidural (CSE)\|url=https://www.asra.com/news-publications/asra-updates/blog-landing/legacy-b-blog-posts/2019/08/07/combined-spinal-epidural-(cse)\|access-date=2022-09-26\|website=The American Society of Regional Anesthesia and Pain Medicine (ASRA)\|language=en}}</ref>. {{Infobox surgical procedure
	\| anesthesia_type = Regional		\| anesthesia_type = Regional
	\| airway = None		\| airway = None
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	===Indications <ref name=":0" />===		===Indications <ref name=":0" />===
	~~General surgery~~

	Labor analgesia		* General, orthopedic, and trauma surgery of lower extremity
			* Urologic and gynecologic surgery
	Cesarean section		* Labor analgesia - more rapid onset pain relief and lower failure rates than standard epidural
			* Cesarean section - rapid onset with ability to prolong anesthesia via epidural catheter
	~~Orthopedic surgery~~

	~~Urologic surgery~~

	===Contraindications <ref>{{Cite book\|url=https://www.worldcat.org/oclc/989157369\|title=Basics of anesthesia\|date=2018\|others=Manuel, Jr. Pardo, Ronald D. Miller, Ronald D. Preceded by: Miller\|isbn=9780323401159\|edition=Seventh edition\|location=Philadelphia, PA\|oclc=989157369}}</ref><!-- List and/or describe the contraindications for this surgical procedure. -->===		===Contraindications <ref>{{Cite book\|url=https://www.worldcat.org/oclc/989157369\|title=Basics of anesthesia\|date=2018\|others=Manuel, Jr. Pardo, Ronald D. Miller, Ronald D. Preceded by: Miller\|isbn=9780323401159\|edition=Seventh edition\|location=Philadelphia, PA\|oclc=989157369}}</ref><!-- List and/or describe the contraindications for this surgical procedure. -->===
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	*Patient refusal		*Patient refusal
	*Localized sepsis		* Localized sepsis
	*Allergy to drugs used in procedure		*Allergy to drugs used in procedure
	*Inability of patient to remain still for injection (risk of neurologic injury)		*Inability of patient to remain still for injection (risk of neurologic injury)
	*Increased intracranial pressure (risk of brainstem herniation)		*Increased intracranial pressure (risk of brainstem herniation)


	Relative contraindications		Relative contraindications

Brooke.Gangwish: Created general outline for CSE article.

2022-09-26T18:28:35Z

Created general outline for CSE article.

← Older revision	Revision as of 11:28, 26 September 2022
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		Combined spinal-epidural (CSE) anesthesia is a neuraxial technique that offers benefits of both spinal and epidural anesthesia and analgesia. The CSE technique involves a subarachnoid injection followed by the placement of a catheter in the epidural space for administration of epidural medications. This permits rapid-onset spinal analgesia, with access for supplementing insufficient subarachnoid anesthesia or prolonging anesthesia and analgesia via the epidural catheter<ref>{{Cite book\|url=https://www.worldcat.org/oclc/70051351\|title=Textbook of regional anesthesia and acute pain management\|date=2007\|publisher=McGraw-Hill, Medical Pub. Division\|others=Admir Hadzic, New York School of Regional Anesthesia\|isbn=0-07-144906-X\|location=New York\|oclc=70051351}}</ref>. Though an ongoing debate, many argue that CSE is associated with lower failure rates and fewer adverse events than spinal or epidural anesthesia<ref name=":0">{{Cite web\|title=Combined Spinal Epidural (CSE)\|url=https://www.asra.com/news-publications/asra-updates/blog-landing/legacy-b-blog-posts/2019/08/07/combined-spinal-epidural-(cse)\|access-date=2022-09-26\|website=The American Society of Regional Anesthesia and Pain Medicine (ASRA)\|language=en}}</ref>. {{Infobox surgical procedure
		\| anesthesia_type = Regional
		\| airway = None
		\| lines_access = PIV
		\| monitors = Standard, EKG
		\| considerations_preoperative =
		\| considerations_intraoperative =
		\| considerations_postoperative =
		}}

		==Overview==

		===Indications <ref name=":0" />===
		General surgery

		Labor analgesia

		Cesarean section

		Orthopedic surgery

		Urologic surgery

		===Contraindications <ref>{{Cite book\|url=https://www.worldcat.org/oclc/989157369\|title=Basics of anesthesia\|date=2018\|others=Manuel, Jr. Pardo, Ronald D. Miller, Ronald D. Preceded by: Miller\|isbn=9780323401159\|edition=Seventh edition\|location=Philadelphia, PA\|oclc=989157369}}</ref><!-- List and/or describe the contraindications for this surgical procedure. -->===
		Absolute contraindications

		*Patient refusal
		*Localized sepsis
		*Allergy to drugs used in procedure
		*Inability of patient to remain still for injection (risk of neurologic injury)
		*Increased intracranial pressure (risk of brainstem herniation)


		Relative contraindications

		*Neurologic: myelopathy or peripheral neuropathy, spinal stenosis, spine surgery, multiple sclerosis, spina bifida
		*Cardiac: aortic stenosis or fixed cardiac output, hypovolemia
		*Hematologic: thromboprophylaxis, anticoagulants, inherited coagulopathy
		*Infection: systemic infection, bacteremia, septic shock

		==Advantages of CSE==

		===CSE vs. Epidural Anesthesia===
		===CSE vs. Spinal Anesthesia===

		===Epidural Volume Extension (EVE)===

		===Use in High-Risk Patients===

		==Technique==

		===Needle-Through-Needle Technique===

		===Separate Needle Technique===

		==Drug Choices==

		==Risks & Complications==

		===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->===

		==References==

		<references />

Chris.Rishel: Chris.Rishel moved page Combined spinal and epidural anesthesia to Combined spinal-epidural anesthesia without leaving a redirect

2021-11-18T18:34:37Z

Chris.Rishel moved page Combined spinal and epidural anesthesia to Combined spinal-epidural anesthesia without leaving a redirect

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2021-11-18T18:33:20Z

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