[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].
In this prospective study we investigated the efficacy of microcatheter spinal anaesthesia in comparison with a combined spinal-epidural technique in trauma patients.


METHODS
After institutional approval 60 patients undergoing urgent lower-limb surgery randomly received either CSA (22 G Sprotte needle, 28 G nylon catheter) in group 1 or CSE (18 G Tuohy needle, 22 G epidural catheter and 25 G pencil-point needle) in group 2. An initial subarachnoid bolus of 2 ml of plain bupivacaine 0.5% was injected in both groups. Difficulties with the lumbar puncture or catheter insertion, the time required for performance of either technique and the onset of analgesia at T12 were documented. If analgesia did not reach T12 within 20 min, supplemental bupivacaine was injected either intrathecally or epidurally up to a maximum of 5 ml in the CSA group or 16 ml in the CSE group.


RESULTS
The number of lumbar punctures (CSA: n = 1.8 +/- 1.5; CSE: n = 2.6 +/- 1.8; P = 0.05) and the incidence of technical problems (CSA: 13%, CSE: 47%; P = 0.012) was higher in the CSE group. In contrast to CSA, performance of CSE was more time consuming (CSA: 8 +/- 3 min, CSE: 15 +/- 8 min; P = 0.0003), and the total dose of local anaesthetics was higher in the CSE group (CSA: 3.2 +/- 1 ml, CSE: 9.7 +/- 5 ml; P < 0.0001).


CONCLUSIONS
Because of the higher incidence of technical problems, more time was required for the performance of CSE. As a consequence, microcatheter CSA might be preferred over CSE in trauma patients.
Wilhelm
S
S
Abteilung für Anästhesiologie, Universitäts-Krankenhaus Eppendorf, Hamburg.
Standl
T
T
D000368:Aged; D000765:Anesthesia, Conduction; D000767:Anesthesia, Epidural / Q000009:adverse effects; D000775:Anesthesia, Spinal / Q000009:adverse effects; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007866:Leg / Q000601:surgery; D008297:Male; D011446:Prospective Studies; D014947:Wounds and Injuries / Q000601:surgery*
CSA vs. CSE bei Patienten in der Unfallchirurgie. Die kombinierte Spinal-Epiduralanästhesie bietet technisch keine Vorteile gegenüber der Spinalanästhesie mit Mikrokatheter.