Combined spinal-epidural anesthesia
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. Though an ongoing debate, many argue that CSE is associated with lower failure rates and fewer adverse events than spinal or epidural anesthesia.
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|Primary anesthetic considerations|
- 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
- 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)
- 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
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. A lower incidence of accidental intravascular epidural catheters, inadequate epidural analgesia, and catheter replacements has been reported in patients who received CSE. 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 .
CSE vs. Spinal Anesthesia
Epidural Volume Extension (EVE)
Use in High-Risk Patients
Separate Needle Technique
Risks & Complications
- 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)
- "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.
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- "Combined Spinal-Epidural Anesthesia". NYSORA. 2018-09-20. Retrieved 2022-10-01.