title: 201 combined spinal-epidurals for anaesthesia using a separate needle technique.
abstract: OBJECTIVE
  Combined spinal-epidural (CSE) anaesthesia may be performed using separate needles or by passing the spinal needle through an epidural needle. The latter technique requires that subarachnoid block is performed before the epidural catheter is placed. This paper examines a series of 201 consecutive CSEs performed with a novel separate needle technique, designed to avoid potential and actual problems associated with the CSE technique.
  
  
  METHODS
  The CSE technique involved placement of the spinal needle in the subarachnoid space, followed by replacement of the spinal needle stylet. The epidural catheter was then positioned separately before returning to the spinal needle and injecting the subarachnoid drug.
  
  
  RESULTS
  The technique had a high technical success rate. Both needles were successfully placed in 200 (99.5%) cases. Spinal anaesthesia was successful in all cases. The epidural catheter was used in 179 cases and failure of the epidural occurred in 2 (1.1%) cases. Paraesthesia, inability to advance the epidural catheter or blood in the epidural catheter occurred in 31 (15.4%) and necessitated immediate replacement of the epidural catheter in 14 (7%) cases. Postoperatively, typical post-dural puncture headache was reported by one patient (0.5%) and mild backache by four (2%). There were no neurological complications.
  
  
  CONCLUSIONS
  This method of CSE anaesthesia can be associated with high success and low complication rates.
authors.affiliation: Royal United Hospital, Combe Park, Bath, England. Timcook@ukgateway.net
authors.forename: T M
authors.initials: TM
authors.lastname: Cook
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D019162:Anesthetics, Combined / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D011446:Prospective Studies; D013346:Subarachnoid Space; D016896:Treatment Outcome
chemical_list: D019162:Anesthetics, Combined