Double-space combined spinal-epidural technique for elective caesarean section: a review of 10 years' experience in a...

In obstetric practice use of a regional technique with a low failure rate minimises the need to convert to general anaesthesia (GA). Previous studies have suggested that combined spinal-epidural anaesthesia (CSE) has a lower GA conversion rate than spinal or epidural anaesthesia alone. In addition, a double-space CSE may be associated with fewer failures than the needle-through-needle technique. However, whether this has an effect on GA conversion rate is unknown. We aimed to review our practice of the double-space CSE technique for elective caesarean section.

Data from 3519 elective caesarean sections performed between 1999 and 2008 using the double-space CSE technique were collected retrospectively from the electronic database, original case records and annual reviews collated by the Department of Obstetric Anaesthesia, St James's University Hospital, Leeds. Complications such as conversion to GA, accidental dural puncture (ADP), post-dural-puncture headache (PDPH) and blood patching were specifically reviewed.

The GA conversion rate in our unit was 0.23% (1:440). The ADP rate was 0.7% (1:141) with a 52% incidence of severe PDPH. The overall need for blood patching was 0.4% (1:251). One in five epidurals was supplemented during caesarean section.

Compared to previously published work using spinal or needle-through-needle CSE anaesthesia we have found a lower GA conversion rate in our unit using the double-space CSE technique for elective caesarean section.