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2016, Number 1

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Invest Medicoquir 2016; 8 (1)

Combined epidural-spinal block in obstetric surgery. Our experience

Mesa GM, López CO, Delgado RD

Language: Spanish
References: 35
Page: 53-67
PDF size: 153.11 Kb.


ABSTRACT

Introduction. Combined epidural-spinal block is a very well accepted regional technique used for surgical procedures below T10 and in obstetric patients. The technique can reduce or eliminate the risk of several disadvantages of spinal or epidural blocks when used separately. Combined epidural-spinal block combines the rapidity, density and safety of spinal anesthesia with the flexibility of continuous epidural block to extend the duration of anesthesia and/or postoperative analgesia. Methods. A small dose of local spinal anesthetic plus an opioid produces excellent analgesia in labor that can be complemented with epidural doses injected via the epidural catheter. The most used combined epidural-spinal technique is to insert the epidural needle to locate the epidural space and, through this needle, introduce the spinal needle for dural puncture, followed by the insertion of the epidural catheter. The following variables were considered: hemodynamic disorders, patient satisfaction, and degree of difficulty to perform the technique, and its complications. Results. Regarding the assessment of the degree of difficulty to carry out the technique, it was easy 86% of the times and difficult 14%; out of this percentage, 75% accounted for difficulty to reach the epidural space and 25% to enter the subarachnoid space with a spinal needle. Conclusions. Combined epidural-spinal block is a safe, suitable alternative to conventional epidural analgesia and has become the preferred technique when providing obstetric analgesia in our hospital.


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