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
| 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 />

Revision as of 10:28, 26 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
Unrated
User likes
0

Overview

Indications [2]

General surgery

Labor analgesia

Cesarean section

Orthopedic surgery

Urologic surgery

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

  1. ↑ 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. ↑ 2.0 2.1 "Combined Spinal Epidural (CSE)". The American Society of Regional Anesthesia and Pain Medicine (ASRA). Retrieved 2022-09-26.
  3. ↑ 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

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