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Anesth Analg 2007;104:745-746
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000251731.61587.6b

LETTER TO THE EDITOR

Section Editor:
Lawrence Saidman

Combined Spinal Epidural Causes a Higher Level of Block than Equivalent, Single-Shot Spinal Anesthesia in Elective Cesarean Patients

Geeta Tayal, MD, Rajinder K. Mittal, MCh, and Sunil Katyal, MD

Department of Plastic Surgery (Tayal, Mittal) Department of Anesthesiology; Dayanand Medical College Hospital; Ludhiana, India; mittaljee{at}yahoo.com (Katyal)

To the Editor:

Ithnin et al. (1) report that entering the epidural space with the epidural needle, without giving any medicine, affects the level of spinal anesthesia. They posit that negative pressure in the epidural space entrains air increasing the pressure in the epidural space. This narrows the intrathecal space, leading to a higher block from intrathecal local anesthetics.

Couldn’t the same phenomenon occur if the stylet is removed from a spinal needle and the tip of the needle is in the epidural space? If so, then this should also result in a higher block.

REFERENCE

  1. Ithnin F, Lim Y, Sia AT, Ocampo CE. Combined spinal epidural causes higher level of block than equivalent single shot spinal anaesthesia in elective cesarean patients. Anesth Analg 2006;102:577–80.[Abstract/Free Full Text]




This Article
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2007 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press