Difference between revisions of "Combined spinal-epidural anesthesia"
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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" />=== | ||
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 | |||
===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 | ||
Revision as of 20:07, 29 September 2022
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[1]. Though an ongoing debate, many argue that CSE is associated with lower failure rates and fewer adverse events than spinal or epidural anesthesia[2].
Combined spinal-epidural anesthesia
| Anesthesia type |
Regional |
|---|---|
| Airway |
None |
| Lines and access |
PIV |
| Monitors |
Standard, EKG |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative | |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Overview
Indications [2]
- General, orthopedic, and trauma surgery of lower extremity
- Urologic and gynecologic surgery
- 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
Contraindications [3]
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
References
- ↑ Textbook of regional anesthesia and acute pain management. Admir Hadzic, New York School of Regional Anesthesia. New York: McGraw-Hill, Medical Pub. Division. 2007. ISBN 0-07-144906-X. OCLC 70051351.CS1 maint: others (link)
- ↑ 2.0 2.1 "Combined Spinal Epidural (CSE)". The American Society of Regional Anesthesia and Pain Medicine (ASRA). Retrieved 2022-09-26.
- ↑ Basics of anesthesia. Manuel, Jr. Pardo, Ronald D. Miller, Ronald D. Preceded by: Miller (Seventh edition ed.). Philadelphia, PA. 2018. ISBN 9780323401159. OCLC 989157369.
|edition=has extra text (help)CS1 maint: others (link)
Top contributors: Brooke R. Gangwish and Chris Rishel