Projects

ABSTRACT
Background: Combined spinal epidural anesthesia (CSEA) technique combines the rapidity of sensory and
motor block by sub arachnoid block(SAB) with the durability of block by epidural block.
Methods: We allocated 52 ASA-I/II patients of either sex,aged between 18 to 60 years scheduled for elective
lower limb orthopaedic surgeries into two groups to receive CSEA.Group I(n=26):Single space technique(SST)
at L3-L4 and Group II(n=26):Double space technique(DST) at L2-L3 & L3-L4. Number of attempts to locate
epidural space and placing spinal needle, appreciating dural click, time for surgical readiness (Ts), two
segments regression time(TR) were noted. Level of sensory and motor blocked were recorded after SAB at
5,10,15,20 minutes.Hemodynamic responses were monitored throughout procedure and surgeries.Incidence of
post-operative back ache was noted till 48hours post procedure.
Results: Demographical data and number of attempts in locating epidural space were statistically
comparable.Number of attempts in placing the spinal needle in Group-I(1±0.27) was lesser than Group-
II(1.77±0.71)(P<0.001). Dural click was appreciated better in Group-I(96%) than Group-II(68%)(P=0.01).Ts
was shorter in Group-I(11.85±3.13min) than Group-II(17.08± 7.97min)(p=0.003). TR of sensory block was
shorter in Group-II(111.32±25.02min) than Group-I(132.31±25.78 min)(P=0.003).Group-I had hypotension
during first 5 to 10 minutes after SAB(p-0.003).The incidence of post-operative back ache was higher in Group-
II(30.77%) than Group-I(3.85%)(p=0.02).
Conclusion: SST requires lesser attempts for SAB and gives better appreciation of dural click than DST. Higher
level of sensory and motor blockade in SST leads to early surgical readiness. But DST provides greater
haemodynamic stability of patients.Thus,SST is better than DST in terms of ease of performance and block
characteristics.
Keywords: Combined spinal epidural,single space,double spaces,dural click