COMBINED SPINAL-EPIDURAL TECHNIQUE

Background. For the past 16 years the combined spinal-epidural (CSE) t echnique has been extensively researched and developed to the point wh ere it is now in widespread use. Along with the use of low-dose mixtur es of local anesthetics and opioids, and the introduction of fine-gaug e pencil-point needles, CSE is being increasingly recognized as anothe r important addition to the armamentarium of the anesthesiologist. Met hod. One hundred and forty-two publications focusing on the CSE techni que, or on questions concerning CSE-related issues, were reviewed. Out of 33 double-blind or controlled studies, 23 directly investigated th e CSE technique. Fifty-four prospective studies and letters made direc tly relevant points on advantages or problems with CSE. Twenty-one boo k chapters, reviews and editorials were included, 11 of them concernin g the use of CSE technique. Results. All CSE techniques which may be u sed for surgical anesthesia, for analgesia in labor or for postoperati ve pain management are described. Indications, advantages, disadvantag es, and the various methods for performing CSE procedures, including s equential CSE block, are described and reviewed, along with the equipm ent currently available for their administration. Conclusion. The CSE technique offers many potential advantages over continuous epidural or subarachnoid methods alone, including a reduction in drug dosage, the ability to eliminate motor blockade and to achieve highly selective s ensory blockade and optimize analgesia. These features hold great prom ise for minimizing the hazards and side effects of traditional epidura l and subarachnoid techniques. Controversial fears, risks, and pitfall s of the CSE technique and of continuous epidural and subarachnoid met hods are debated and discussed.