+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Paramedian epidural with midline spinal in the same intervertebral space: An alternative technique for combined spinal and epidural anaesthesia



Paramedian epidural with midline spinal in the same intervertebral space: An alternative technique for combined spinal and epidural anaesthesia



Indian Journal of Anaesthesia 57(4): 364-370



Although different techniques have been developed for administering combined spinal epidural (CSE) anaesthesia, none can be described as an ideal one. WE PERFORMED A STUDY TO COMPARE TWO POPULAR CSE TECHNIQUES: Double segment technique (DST) and single segment (needle through needle) technique (SST) with another alternative technique: Paramedian epidural and midline spinal in the same intervertebral space (single space dual needle technique: SDT). After institutional ethical clearance, 90 consenting patients undergoing elective lower limb orthopaedic surgery were allocated to receive CSE into one of the three groups (n=30 each): Group I: SST, Group II: SDT, Group III: DST using computerized randomization. The time for technique performance, surgical readiness, technical aspects of epidural and subarachnoid block (SAB) and morbidity were compared. SDT is comparable with SST and DST in time for technique performance (13.42±2.848 min, 12.18±6.092 min, 11.63±3.243 min respectively; P=0.268), time to surgical readiness (18.28±3.624 min, 17.64±5.877 min, 16.87±3.137 min respectively; P=0.42) and incidence of technically perfect block (70%, 66.66%, 76.66%; respectively P=0.757). Use of paramedian route for epidural catheterization in SDT group decreases complications and facilitates catheter insertion. There was a significant number of cases with lack of dural puncture appreciation (SST=ten, none in SDT and DST; P=0.001) and delayed cerebrospinal fluid reflux (SST=five, none in SDT and DST; P=0.005) while performance of SAB in SST group. The incidence of nausea, vomiting, post-operative backache and headache was comparable between the three groups. SDT is an acceptable alternative to DST and SST.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 054861308

Download citation: RISBibTeXText

PMID: 24163450

DOI: 10.4103/0019-5049.118559


Related references

A comparison between midline and paramedian approaches for combined spinal-epidural anesthesia. Masui. Japanese Journal of Anesthesiology 50(10): 1085-1088, 2001

Potential intrathecal leakage of solutions injected into the epidural space following combined spinal epidural anaesthesia. Anaesthesia and Intensive Care 26(3): 256-261, 1998

A comparison between epidural anaesthesia using alkalinized solution and spinal (combined spinal/epidural) anaesthesia for elective caesarean section. International Journal of Obstetric Anesthesia 5(4): 236-239, 1996

Combined spinal epidural anaesthesia - single space double barrel technique. International Journal of Obstetric Anesthesia 5(3): 206-7; Author Reply 207, 1996

Combined spinal epidural anaesthesia: the single space double-barrel technique. International Journal of Obstetric Anesthesia 4(3): 158-160, 1995

Combined epidural/spinal anaesthesia for caesarean section--single-space double-barrel technique. Anaesthesia 47(9): 814, 1992

Case report: difficulty in diagnosis of delayed spinal epidural hematoma in puerperal women after combined spinal epidural anaesthesia. Bmc Anesthesiology 19(1): 54, 2019

Single-shot spinal anaesthesia, combined spinal-epidural and epidural volume extension for elective caesarean section: a randomized comparison. International Journal of Obstetric Anesthesia 18(3): 231-236, 2009

The comparison of low-dose combined spinal-epidural, spinal, and epidural anaesthesia in caesarean section. European Journal Of Anaesthesiology. 18(Suppl. 21): 109-110, 2001

Success of epidural catheters placed for postoperative analgesia Comparison of a combined spinal-epidural technique vs a standard epidural technique. Anesthesiology 89(3A): A1095, Sept, 1998

Combined spinal epidural anaesthesia is better than spinal or epidural alone for Caesarean delivery. British Journal of Anaesthesia 91(2): 299-300, 2003

Continuous spinal anesthesia vs. combined spinal-epidural anesthesia in emergency surgery. The combined spinal-epidural anesthesia technique does not offer an advantage of spinal anesthesia with a microcatheter. Der Anaesthesist 46(11): 938-942, 1998

Low-dose spinal anesthesia using combined spinal and epidural technique for cesarean delivery An intrathecal opioid, not epidural injection of saline, improves intraoperative analgesia. Regional Anesthesia & Pain Medicine 26(6): 588-589, November-December, 2001

Low-dose combined spinal-epidural anaesthesia vs. conventional epidural anaesthesia for Caesarean section in pre-eclampsia: a retrospective analysis. European Journal of Anaesthesiology 21(6): 454-459, 2004

Dural Puncture Epidural Technique Improves Labor Analgesia Quality With Fewer Side Effects Compared With Epidural and Combined Spinal Epidural Techniques. Obstetric Anesthesia Digest 37(3): 158-160, 2017