Benefits: Rapid onset of action (spinal anesthesia action) Good block and good muscle relaxation (spinal anesthesia) Spread of anesthesia is optimized, anesthesia can be prolonged (epidural) Post-operative analgesia can be achieved (via epidural anesthesia)
Indications for the CSE technique 1.Obstetrics * (cesarean section, labor analgesia) 2.Gynecologic surgery 3.Orthopedic surgery 4.Urologic surgery 5.Major vascular surgery 6.Pediatric surgery 7.Ambulatory surgery
Various options for CSE technique 1.Double needle (needle- through- needle) - single interspace* 2.Double catheter ( catheters in epidural and subarachnoid spaces) 3.Double needle- separate interspaces 4.Double needle (needle- beside- needle) - single interspace
Correct placement of the spinal needle is confirmed by free flow or aspiration of CSF and if loss of resistance to air is employed to identify the epidural space any clear fluid coming out of the spinal needle will be CSF.
After withdrawing the spinal needle, a catheter is introduced about 4-5 cm into the epidural space through the tuohy needle. Misplacement of the epidural catheter is tested by aspiration for blood or CSF.