Combination of unilateral spinal anesthesia and combined spinal epidural anesthesia

Abstract

The effectiveness of the combination of unilateral spinal anesthesia (USA) and combined spinal epidural anesthesia (CSEA) was examined in a prospective clinical study. 25 ASA I-II patients, who underwent operations in which USA can be applied, were positioned in a lateral decubitus position with the operative side downwards. After the Tuohy needle of a CSEA-set was inserted through L3-L4 interspace into the epidural space, the spinal needle of the same set was inserted. 1.5 ml of hyperbaric bupivacaine % 0.5 was injected into the subarachnoid space. Afterwards, an epidural catheter was inserted through the Tuohy needle. Following the procedure, patients were observed regarding the sensory and motor blocks in both sides and the hemodynamic parameters, without any position change. In one patient bradicardia and in another one hypotension was observed. In 2 patients (8 %), spinal anesthesia was insufficient, so it had been necessary to use the epidural component to obtain the anesthesia for the operation. In all the other patients, epidural catheter was used for postoperative analgesia. Unilateral sensory and motor blocks exclusively on the operative side were observed in 40 % and 88 % of the patients respectively. Sensory block on the operative side reached T9 (T5-T12) level, as motor block was 3 (2-3) on Bromage scale. It was concluded that the combination of USA and CSEA can be an easy, reliable and comfortable method, where further studies comparing different doses are necessary.