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Anesth Analg 2007;104:746
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000251733.77172.ee

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

F. Ithnin, Y. Lim, A. T. Sia, and C. E. Ocampo

Department of Women’s Anesthesia; KK Women’s and Children’s Hospital; Singapore; yvel6{at}hotmail.com

In Response:

As noted by Geeta et al., (1) our study (2) showed that the combined spinal epidural technique conferred a higher sensory block than the single spinal shot technique for parturients undergoing elective cesarean delivery. The mechanism suggested in our article, loss of negative pressure in the epidural space, is speculation. The letter from Geeta et al. suggests a possible study: if removing the stylet of a spinal needle while the tip is in the epidural space produces a higher block, this would add to the evidence (3,4) supporting our conjecture.

REFERENCES

  1. Geeta, Katyal S, Mittal RK. A combined spinal epidural causes a higher level of block than equivalent, single-shot spinal anesthesia in elective cesarean patients. Anesth Analg 2007;104:745–6.[Free Full Text]
  2. Ithnin F, Lim Y, Sia AT, Ocampo CE. Combined spinal epidural causes higher block than equivalent single shot spinal anesthesia in elective cesarean patients. Anesth Analg 2006;102:577–80.[Abstract/Free Full Text]
  3. Goy RW, Sia AT. Sensorimotor anesthesia and hypotension after subarachnoid block: combined spinal-epidural versus single-shot spinal technique. Anesth Analg 2004;98:491–6.[Abstract/Free Full Text]
  4. Goy RW, Chee-Seng Y, Sia AT, et al. 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 2005;100:1499–502.[Abstract/Free Full Text]




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Lippincott, Williams & Wilkins 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 HighWire Press