The Effects of Combined Spinal Epidural Anesthesia for Lower Extremity Surgery

Ki, Sam Seo; So, Geum Young; Chung, Chong Dal

Abstract

BACKGROUND: Spinal anesthesia is a simple technique requiring a small dose of local anesthetic to provide intense and reliable block. And epidural anesthesia with the catheter technique gives a better control of the level of analgesia and a good postoperative pain relief using opioids, local anestheties or both. Therefore, the combined spinal epidural (CSE) anesthesia was evaluated to provide rapid onse of action, good muscle relaxation, prolonged duration of the block and postoperative pain relief.
METHODS
All patients were placed in a lateral position. Using a midline approach at L interspace, a 18G Tuohy needle was introduced into the epidural space. A 27G Whitacre spinal needle was passed through the Tuohy needle until free flow cerebrospinal fluid, and than 0.5% heavy bupivacaine 3ml(15mg) was injected. The spinal needle was withdrawn and the epidural catheter was inserted. The dermatome level and time of sensory block was evaluated using loss of sensation of pinprick test every 1 minute for 30 minutes, until the maximum sensory block was established. Motor block was assessed using the Bromage scale. And postoperatively we interviewed the patients for opinioes on the blockade and complication.
RESULTS
The mean values of maximum sensory block level were T8 (T8.0+/-1.7 dermatome) and at that time was 8min 30sec (8.5+/-1.2min). The motor blockade of lower extremity was Bromage 3 in all patients. Prolonged anesthesia over 2 hours of operation was accomplished by adding 0.5% bupivacaine through epidural catheter. Subjective evaluation by the patients about postoperative pain control was excellent.
CONCLUSIONS
CSE anesthesia appears to combine the reliabiIity and rapid onset of spinal block, and the ability to extend the block and postoperative analgesia by using the epidural catheter while minimizing their drawbacks.