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Continuous spinal anesthesia: where do spinal catheters go?

E F Van Gessel1, A Forster, Z Gamulin

  • 1Département d'anesthésiologie, Hôpital Cantonal Universitaire, Geneve, Switzerland.

Anesthesia and Analgesia
|May 1, 1993
PubMed
Summary
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This study examined technical issues in continuous spinal anesthesia, finding that while lumbar puncture level was often misjudged, catheter insertion was successful. Catheter tip position influenced block height in elderly patients undergoing hip surgery.

Area of Science:

  • Anesthesiology
  • Neurosurgery

Background:

  • Continuous spinal anesthesia (CSA) is a technique used for prolonged surgical procedures.
  • Technical challenges can arise during CSA catheter placement, potentially affecting anesthetic efficacy.

Purpose of the Study:

  • To assess technical difficulties during continuous spinal anesthesia catheter insertion.
  • To evaluate the impact of catheter tip position on block height after administering hypobaric spinal anesthetic.

Main Methods:

  • Twenty-nine elderly patients undergoing hip surgery received continuous spinal anesthesia.
  • Lumbar puncture was performed using an 18-gauge Tuohy needle; catheter insertion was defined as easy or difficult.
  • Hypobaric spinal anesthetic (7.5 mg bupivacaine or tetracaine) was administered, and sensory levels were assessed.

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  • Post-operative radiography confirmed catheter tip position.

    • Main Results:

    • Lumbar puncture level was inaccurately determined in 59% of cases.
    • Despite some threading difficulties (4/28 cases), catheter insertion success rate was 100%.
    • Catheter tip positions varied: 20 cephalad, 6 horizontal, and 2 caudal; one catheter dislodged into the epidural space.

    Conclusions:

    • Continuous spinal anesthesia catheterization can be technically challenging, particularly regarding accurate landmark identification.
    • Catheter tip position is a critical factor influencing the spread and height of spinal anesthesia, even with hypobaric agents.
    • Despite potential difficulties, successful catheter insertion is achievable, highlighting the importance of technique and post-placement verification.