Combined Spinal Epidural Anaesthesia

Development in anaesthesia and surgery has improved over all surgical outcome during recent decades. There is still concern about the detrimental effects of operative procedures such as myocaridial infarction, pulmonary complications, thromboembolism, gastrointestinal paralysis, immunosupression etc. that cannot be attributed solely to imperfections in surgical technique. Regional anaesthesia offers safe, effective, cheap anaesthesia over general anaesthesia. Combined Spinal and Epidural Anaesthesia (CSE). offers advantages over the epidural or single injection spinal anaesthesia alone. CSE combines the benefits of certainity with a definitive end point (the appearance of cerebrospinal fluid) that is characteristic of spinal anesthesia with flexibility of continuous epidural anaestheisia . It involves the use of a minimal dose of spinal anaesthetic for a shorter duration but allows flexibility of epidural reinforcement if necessary. CSE is like “to paint the fence” from both its sides. The spectrum of indications are those of the spinal or epidural alone or even more & range from labour analgesia to high abdominal & even thoracic & head operations by the adjuvant use of an endotracheal tube ventilation. The commonest indications are hip replacement surgery followed by hysterectomy, knee surgery, cesarean section, femur fracture in elderly, prostatectomy. This technique has been used for about 15 years without any reports of a unique or major complications attributed to the technique (1,2). There are four main varieties of CSEA, and a review of its history provides the opportunity to Anuradha Bali, Juhi Sharma, Satya Dev Gupta