JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (15) Citing Articles via Google Scholar Google Scholar Articles by Goy, R. W.-L. Articles by Sia, A. T.-H. Search for Related Content PubMed PubMed Citation Articles by Goy, R. W.-L. Articles by Sia, A. T.-H. Related Collections Cardiovascular Regional Anesthesia

---

OBSTETRIC ANESTHESIA

Sensorimotor Anesthesia and Hypotension After Subarachnoid Block: Combined Spinal-Epidural Versus Single-Shot Spinal Technique

From the Department of Anesthesia, KK Women’s and Children’s Hospital, Singapore

Address correspondence and reprint requests to Raymond W. Goy, Department of Anesthesia, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229 899. Address email to raygoywl{at}singnet.com.sg

The extent of the intrathecal compartment depends on the balance between cerebrospinal fluid and subatmospheric epidural pressure. Epidural insertion disrupts this relationship, and the full impact of loss-of-resistance on the qualities of subarachnoid block is unknown. In this study we sought to determine if subarachnoid block, induced by combined spinal-epidural (CSE) using loss-of-resistance to air could render higher sensory anesthesia than single-shot spinal (SSS) when an identical mass of intrathecal anesthetic was injected. Sixty patients, scheduled for minor gynecological procedures, were randomly allocated into three groups all receiving 10 mg of 0.5% hyperbaric bupivacaine. In the SSS group, intrathecal administration was through a 27-gauge Whitacre spinal needle inserted at the L3-4 level. For the CSE group, the epidural space was identified with an 18-gauge Tuohy needle using loss-of-resistance to 4 mL of air. After intrathecal administration, a 20-gauge catheter was left in the epidural space. No further drug or saline was administered through the catheter. The procedure was repeated in group CSE _{(no-catheter)} except without insertion of a catheter. Sensorimotor anesthesia was assessed at regular 2.5-min intervals until T10 was reached. In all aspects, there was no difference between CSE and CSE _{(no-catheter)}. Peak sensory level in SSS was lower than CSE and CSE _{(no-catheter)} (median T5 [max T3–min T6] versus (T3 [T1–4] and (T3 [T2–5]) (P < 0.01). During the first 10 min postblock, dermatomal thoracic block was the lowest in SSS (P < 0.05). Time for regression of sensory level to T10 was also shortest in SSS. Hypotension, ephedrine use and period of motor recovery were more pronounced in CSE and CSE _{(no-catheter)}. We conclude that subarachnoid block induced by CSE produces greater sensorimotor anesthesia and prolonged recovery compared with SSS. There is also a more frequent incidence of hypotension and vasoconstrictor use despite using identical doses and baricity of local anesthetic.

IMPLICATIONS: This study confirms that induction of subarachnoid block by a combined-spinal epidural technique produces a greater sensorimotor anesthesia and results in prolonged recovery when compared with a single-shot spinal technique. There is a more frequent incidence of hypotension and vasoconstrictor administration despite identical doses of intrathecally administered local anesthetic.

This article has been cited by other articles:

				D. J. Horstman, E. T. Riley, and B. Carvalho A Randomized Trial of Maximum Cephalad Sensory Blockade with Single-Shot Spinal Compared with Combined Spinal-Epidural Techniques for Cesarean Delivery Anesth. Analg., January 1, 2009; 108(1): 240 - 245. [Abstract] [Full Text] [PDF]

				F. Ithnin, Y. Lim, A. T. Sia, and C. E. Ocampo Combined Spinal Epidural Causes a Higher Level of Block than Equivalent, Single-Shot Spinal Anesthesia in Elective Cesarean Patients Anesth. Analg., March 1, 2007; 104(3): 746 - 746. [Full Text] [PDF]

				Y. Lim, W. Teoh, and A. T. Sia Combined Spinal Epidural Does Not Cause a Higher Sensory Block than Single Shot Spinal Technique for Cesarean Delivery in Laboring Women Anesth. Analg., December 1, 2006; 103(6): 1540 - 1542. [Abstract] [Full Text] [PDF]

				F. Ithnin, Y. Lim, A. T. Sia, and C. E. Ocampo Combined Spinal Epidural Causes Higher Level of Block than Equivalent Single-Shot Spinal Anesthesia in Elective Cesarean Patients Anesth. Analg., February 1, 2006; 102(2): 577 - 580. [Abstract] [Full Text] [PDF]

				R. W.-L. Goy, Y. Chee-Seng, A. T.-H. Sia, K. Choo-Kok, and S. Liang The Median Effective Dose of Intrathecal Hyperbaric Bupivacaine Is Larger in the Single-Shot Spinal as Compared with the Combined Spinal-Epidural Technique Anesth. Analg., May 1, 2005; 100(5): 1499 - 1502. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999