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1、Anaesthesia,2000,55,pages42±64...............................................................................................................................................................................................................................
2、.................REVIEWARTICLECombinedspinal±epiduraltechniquesT.M.CookConsultantAnaesthetist,RoyalUnitedHospital,CombePark,BathBA13NG,UKSummaryThecombinedspinal±epiduraltechniquehasbeenusedincreasinglyoverthelastdecade.Combinedspinal±epiduralmayachieve
3、rapidonset,profoundregionalblockadewiththefacilitytomodifyorprolongtheblock.Avarietyoftechniquesanddeviceshavebeenproposed.Thetechniquecannotbeconsideredsimplyasanisolatedspinalblockfollowedbyanisolatedepiduralblockascombiningthetechniquesmayaltereachbl
4、ock.Thisreviewconcentratesontechnicalandproceduralaspectsofcombinedspinal±epidural.Needle-through-needle,separate-needleandcombined-needletechniquesaredescribedandmodi®cationsdiscussed.Failureratesandcausesarereviewed.Theproblemsofperformingaspinalblock
5、beforeepiduralblockade(potentialforunrecognisedplacementofanepiduralcatheter,inabilitytodetectparaesthesiaduringepiduralplacement,dif®cultyintestingtheepidural,delayinpositioningthepatient)aredescribedandevaluated.Problemsofperformingspinalblockafterepi
6、duralblockade(riskofcatheterorspinalneedledamage)areconsidered.Mechanismsofmodi®cationofspinalblockadebysubsequentepiduraldrugadministrationarediscussed.Thereviewconsiderschoiceoftechnique,needletype,patientpositioningandparamedianvs.midlineapproach.Fin
7、ally,complicationsassociatedwithcombinedspinal±epiduralarereviewed.KeywordsAnaesthesia,regional;combinedspinal±epidural.......................................................................................Correspondenceto:DrT.M.CookAccepted:17July1999T
8、hecombinedspinal±epiduraltechnique(CSE)involvesmodifythespinalblockandepiduraldrugsmaynotbehaveintentionalsubarachnoidblockadeandepiduralcatheterastheywouldwithoutpriorduralpuncture.placementduringthesameprocedure.CSEallowsarapid
