Combined Spinal Epidural Anesthesia and Analgesia

In principle, the combination of two different administration of anesthesia routes on the same patient improves effectiveness and reduces side effects (Stevens and Edwards, 1999) [B]: Spinal anesthesia provides fast and reliable segmental anesthesia with minimal risk for toxicity, while epidural anesthesia provides perioperative anesthesia (alone or in combination with general anesthesia), followed by excellent analgesia in the postoperative period (Cook, 2000;Rawal et al., 2000) [A]. Moreover, Combined Spinal Epidural (CSE) anesthesia reduces the potential for problems, such as the somewhat unpredictable level of blockade after spinal anesthesia, and the problems of missed segments, incomplete motor block, poor sacral spread and local anesthetic toxicity that can occur with epidural anesthesia (Cook, 2000) [A]. At the present time, CSE anesthesia is widely used in orthopedic, urologic and gynecologic surgery. Major CSE anesthesia benefits are the need for low doses of medications, low incidence of motor blockade, adequate sensory block, the ability to extend the area of blockade if the surgical field needs to be extended, and excellent analgesia (Rawal et al., 1997) [A]. However, use of CSE anesthesia or analgesia also introduces the potential for complications, such as technical failure, altered spread of epidural drugs in patients who also had a lumbar puncture, and altered spread of subarachnoid medications due to the effects of the epidural injection.