COMBINED SPINAL EPIDURAL VERSUS EPIDURAL ANAESTHESIA IN MAJOR SURGERIES

BACKGROUND Combined spinal epidural anaesthesia is a comparatively recent innovation in the central neuraxial anaesthetic procedures. With proper patient and needle selection, we believe that CSEA may offer advantages over both spinal and epidural anaesthesia for outpatient surgery as well. Compared with spinal anaesthesia CSEA offers increased flexibility, because the duration of anaesthesia can be extended using the epidural catheter. Combined spinal epidural anaesthesia may also provide a decreased duration of anaesthesia by allowing administration of the minimal intrathecal dose required to establish the initial level of surgical anaesthesia. This is made possible because of the confidence afforded by the continuous techniques as a backup. Compared with epidural anaesthesia alone, CSEA has a shorter onset and virtually eliminates most of the serious complications of epidural and spinal anaesthesia. MATERIALS AND METHODS This prospective, randomised, controlled study was conducted at a tertiary care hospital incorporating 60 patients. Patients were divided into two groups using computer-generated random number table. In Group-I of 30 patients CSEA was used, while in Group-II of 30 patients EA was used. RESULTS The demographic profile of the patients in both groups was comparable with regards to age, weight and height. In Group-I the mean dose of intrathecal, extradural and total Bupivacaine was 11.07 +/- 1.38 mg, 15.63 +/- 3.13 mg and 28.60 +/- 3.74 mg respectively. In CSEA group of 30 patients the CSE needle was inserted successfully in 93.4%, of which in about 92.8% cases of extradural catheter was placed successfully, while in EA group the epidural needle was inserted successfully in 93.3%, which in 89.3% cases the extradural catheter was placed successfully. CONCLUSION A statistically significant and progressive fall in pulse rate and blood pressure was noted in first 10 mins of combined spinal epidural anaesthesia group and in between 10-30 mins of epidural anaesthesia group and in between 10-30 mins of epidural anaesthesia group. This fall was noted because of autonomic nervous system blockade. In epidural anaesthesia group, the mean fall in blood pressure was between 20-30 mins and was comparatively more than in CSEA group.