Combined spinal and epidural anaesthesia

Combined spinal and epidural anaesthesia or analgesia is a regional anaesthetic technique administered by an anesthesiologist or Certified Registered Nurse Anesthetist working alone or together.

It has the benefits of both spinal anaesthesia and epidural anaesthesia. The spinal component gives a rapid onset of a predictable block. The indwelling epidural catheter gives the ability to provide long lasting analgesia and to titrate the dose given to the desired effect.

The needle-through-needle technique involves the introduction of a large-bore (16G or 18G) epidural needle into the epidural space. A long fine spinal needle (25G) is then introduced via the lumen of the epidural needle and through the dura, into the subdural space. A small pop is felt as the dura is punctured, and the correct position is confirmed when spinal fluid can be aspirated from the spinal needle. A small quantity of local anaesthetic and an opioid such as fentanyl, is then injected; the spinal needle withdrawn and the epidural catheter inserted.

This technique is suitable whenever a rapid onset of analgesia is required but the period of analgesia required exceeds that of a single spinal injection. It is commonly used for Caesarean sections.

This technique shares the contraindications and complications of both procedures. This technique allows for post operative pain relief via epidural patient controlled anesthesia. The epidural catheter is left in place for a day or so. Common agents are hydromorphone or a weak local anesthetic and an opiate.

Kombinierte Spinal- und Epiduralanästhesie