Development and Current Status of Combined Spinal Epidural Anaesthesia

Abstract

Combined spinal and epidural anaesthesia/analgesia is a method wherebydrugs are applied intrathecally as a single dose and epidurally eithercontinuously or intermittently via an epidural catheter. More than50 years ago, first attempts were made to introduce this method intoclinical practice but they found little general acceptance. Onlyduring the last decades has tremendous progress been made in developingnew, highly-sophisticated equipment: matching spinal and epiduralneedles and catheters, epidural needles with a separate conduit forthe spinal needle or with an additional hole for the exit of thespinal needle as well as fixation devices for the spinal needle.A specific feature of the method is the only recently recognisedepidural volume extension, which allows the use of low-dose drugcombinations with sufficient analgetic properties but less cardiovascularcompromise and fewer side-effects. This review describes the mainand most important developmental steps and offers practical examplesfor its use in day-case surgery of the lower limb, in the "walkingepidural" in obstetrics and in caesarean section. The method hasbecome a valuable new tool in the armamentarium of the anaesthetistand part of daily routine in many clinics.