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Updated: Feb 22, 2026

Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy
Published on: January 31, 2025
Combined spinal-epidural anesthesia for cesarean section; needle-through-needle approach
Toshinori Tsutsui1, Kumiko Nakamura2, Kenji Muranaka3
1Department of Anesthesiology, National Saga Hospital, 1-20-1 Hinode, 849, Saga, Saga, Japan.
The Portex needle set enables combined spinal-epidural (CSE) anesthesia for cesarean sections, offering a quick and reliable option. This technique provides effective analgesia and postoperative pain relief with minimal complications.
Area of Science:
- Anesthesiology
- Obstetric Anesthesia
Background:
- Combined spinal-epidural (CSE) anesthesia is a technique used for surgical procedures.
- The Portex "Spinal/Epidural Set" facilitates the needle-through-needle approach for CSE.
Purpose of the Study:
- To evaluate the technical and clinical utility of CSE using the Portex needle set and isobaric tetracaine for cesarean sections.
Main Methods:
- Thirty patients undergoing cesarean section were included.
- A 16-gauge epidural needle was inserted, followed by a 26-gauge spinal needle through it.
- Isobaric tetracaine was administered intrathecally, and a 17-gauge epidural catheter was placed.
Main Results:
- Successful first-attempt insertion was achieved in 70% of patients.
- Spinal anesthesia reached the Th6 level on average; 13% required epidural supplementation.
- No postspinal headaches were reported, and no accidental subarachnoid catheterization occurred.
Conclusions:
- The needle-through-needle CSE technique is user-friendly.
- It offers rapid, dependable, and adaptable analgesia for cesarean delivery.
- This method also provides effective postoperative pain management.
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