[Combined subarachnoid and epidural block with a single injection, with a modified Tuohy needle and used in hip...

To evaluate prospectively the advantages and disadvantages of a combined subarachnoid and epidural block with a modified Tuohy needle during hip surgery.

Fifty ASA II-III patients undergoing full hip arthroplasty were studied. The same technique was used with all patients; 2 ml of 0.5% hyperbaric bupivacaine (10 mg) was used for the subarachnoid block. Ten ml of 2% lidocaine (200 mg) was injected by epidural catheter into 25 patients (group I); 5 ml of 0.5% bupivacaine (25 mg) was injected into the others (group II). A Tuohy 17 G needle with a Huber point and supplemental orifice for a 26 G intradural needle was used, along with an epidural catheter. The level of difficulty of the technique was evaluated, as were unusual events, the metameric level of sensory block reached, and intraoperative (hypotension, bradycardia or both) and postoperative (head or lower back pain) complications.

The level of difficulty was nil in 60% of the cases, average in 26% and high in 14%. The quality of the motor-sensory blockade was excellent and the thoracic level of sensory blockade (mean +/- SD) was 6.2 +/- 1.4 for group I and 8.2 +/- 1.1 for group II. The difference between the two groups was significant (p < 0.05). Hypotension was found in 6% of all patients, bradycardia in 20% and both in 14%, with no significant differences between the two groups. No case of headache was reported and the level of patient satisfaction with the anesthesia was excellent in 92% of the cases.

A combined subarachnoid (10 mg hyperbaric bupivacaine) and epidural (200 mg lidocaine or 25 mg bupivacaine) blockade provides an excellent sensory block with few side effects. The technique facilitates epidural treatment of postoperative pain.