Combined spinal-epidural anaesthesia

The purpose of this review is to present the most important recent studies on the clinical use of the combined spinal-epidural technique.

The predominant recent literature on the combined spinal-epidural technique involves its use in obstetrics. A 2004 UK survey showed that the use of the technique is increasing. Studies are presented which show the role of intrathecal drug selection for improving the quality of the combined spinal-epidural technique for anaesthesia for Caesarean section. The pros and cons of using the method as opposed to traditional epidural for labour analgesia are still being debated; the results of a meta-analysis show that combined spinal-epidural provides faster onset of analgesia and increased maternal satisfaction but the incidence of pruritus is high. This review also looks at some technical aspects of the technique.

The use of combined spinal-epidural is widespread and increasing particularly in obstetric anaesthesia and analgesia. Recent literature provides new information about the choice of drugs and technical aspects of the technique and also about its advantages and drawbacks in obstetric and non-obstetric patients.