https://wikianesthesia.org/w/api.php?action=feedcontributions&feedformat=atom&user=Brooke.GangwishWikiAnesthesia - User contributions [en]2026-05-01T15:37:54ZUser contributionsMediaWiki 1.37.1https://wikianesthesia.org/w/index.php?title=Combined_spinal-epidural_anesthesia&diff=14093Combined spinal-epidural anesthesia2022-10-01T22:15:59Z<p>Brooke.Gangwish: </p>
<hr />
<div>'''Combined spinal-epidural''' (CSE) anesthesia is a neuraxial technique that offers benefits of both spinal and epidural anesthesia and analgesia. The CSE technique involves a subarachnoid injection followed by the placement of a catheter in the epidural space for administration of epidural medications. This permits rapid-onset spinal analgesia, with access for supplementing insufficient subarachnoid anesthesia or prolonging anesthesia and analgesia via the epidural catheter<ref name=":1">{{Cite book|url=https://www.worldcat.org/oclc/70051351|title=Textbook of regional anesthesia and acute pain management|date=2007|publisher=McGraw-Hill, Medical Pub. Division|others=Admir Hadzic, New York School of Regional Anesthesia|isbn=0-07-144906-X|location=New York|oclc=70051351}}</ref>. Though an ongoing debate, many argue that CSE is associated with lower failure rates and fewer adverse events than spinal or epidural anesthesia<ref name=":0">{{Cite web|title=Combined Spinal Epidural (CSE)|url=https://www.asra.com/news-publications/asra-updates/blog-landing/legacy-b-blog-posts/2019/08/07/combined-spinal-epidural-(cse)|access-date=2022-09-26|website=The American Society of Regional Anesthesia and Pain Medicine (ASRA)|language=en}}</ref>. {{Infobox surgical procedure<br />
| anesthesia_type = Regional<br />
| airway = None<br />
| lines_access = PIV<br />
| monitors = Standard, EKG<br />
| considerations_preoperative = <br />
| considerations_intraoperative = <br />
| considerations_postoperative = <br />
}}<br />
<br />
==Overview==<br />
<br />
===Indications <ref name=":0" />===<br />
<br />
* General, orthopedic, and trauma surgery of lower extremity<br />
* Urologic and gynecologic surgery<br />
* Labor analgesia - more rapid onset pain relief and lower failure rates than standard epidural<br />
* Cesarean section - rapid onset with ability to prolong anesthesia via epidural catheter<br />
<br />
===Contraindications <ref>{{Cite book|url=https://www.worldcat.org/oclc/989157369|title=Basics of anesthesia|date=2018|others=Manuel, Jr. Pardo, Ronald D. Miller, Ronald D. Preceded by: Miller|isbn=9780323401159|edition=Seventh edition|location=Philadelphia, PA|oclc=989157369}}</ref><!-- List and/or describe the contraindications for this surgical procedure. -->===<br />
Absolute contraindications<br />
<br />
*Patient refusal<br />
* Localized sepsis<br />
*Allergy to drugs used in procedure<br />
*Inability of patient to remain still for injection (risk of neurologic injury)<br />
*Increased intracranial pressure (risk of brainstem herniation)<br />
Relative contraindications<br />
<br />
Relative contraindications<br />
<br />
*Neurologic: myelopathy or peripheral neuropathy, spinal stenosis, spine surgery, multiple sclerosis, spina bifida<br />
*Cardiac: aortic stenosis or fixed cardiac output, hypovolemia<br />
*Hematologic: thromboprophylaxis, anticoagulants, inherited coagulopathy<br />
*Infection: systemic infection, bacteremia, septic shock<br />
<br />
==Advantages of CSE==<br />
<br />
===CSE vs. Epidural Anesthesia===<br />
The CSE technique provides more rapid onset analgesia and establishes surgical anesthesia 15-20 minutes faster than epidural anesthesia. CSE is also associated with lower failure rates and fewer adverse events<ref name=":1" />. A lower incidence of accidental intravascular epidural catheters, inadequate epidural analgesia, and catheter replacements has been reported in patients who received CSE<ref>{{Cite web|date=2018-09-20|title=Combined Spinal-Epidural Anesthesia|url=https://www.nysora.com/topics/regional-anesthesia-for-specific-surgical-procedures/abdomen/combined-spinal-epidural-anesthesia/|access-date=2022-10-01|website=NYSORA|language=en}}</ref>. Higher success rates may be due to confirmation of epidural space via CSF return with spinal needle. More complete sensory blockade with improved sacral spread has also been reported with CSE, though local anesthetic flux through the dural puncture site also varies with choice of spinal needle <ref name=":0" />. <br />
<br />
===CSE vs. Spinal Anesthesia===<br />
<br />
===Epidural Volume Extension (EVE)===<br />
<br />
===Use in High-Risk Patients===<br />
<br />
==Technique==<br />
<br />
===Needle-Through-Needle Technique===<br />
<br />
===Separate Needle Technique===<br />
<br />
==Drug Choices==<br />
<br />
==Risks & Complications==<br />
<br />
===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->===<br />
<br />
==References==<br />
<br />
<references /></div>Brooke.Gangwishhttps://wikianesthesia.org/w/index.php?title=Combined_spinal-epidural_anesthesia&diff=14090Combined spinal-epidural anesthesia2022-09-30T04:07:57Z<p>Brooke.Gangwish: </p>
<hr />
<div>'''Combined spinal-epidural''' (CSE) anesthesia is a neuraxial technique that offers benefits of both spinal and epidural anesthesia and analgesia. The CSE technique involves a subarachnoid injection followed by the placement of a catheter in the epidural space for administration of epidural medications. This permits rapid-onset spinal analgesia, with access for supplementing insufficient subarachnoid anesthesia or prolonging anesthesia and analgesia via the epidural catheter<ref>{{Cite book|url=https://www.worldcat.org/oclc/70051351|title=Textbook of regional anesthesia and acute pain management|date=2007|publisher=McGraw-Hill, Medical Pub. Division|others=Admir Hadzic, New York School of Regional Anesthesia|isbn=0-07-144906-X|location=New York|oclc=70051351}}</ref>. Though an ongoing debate, many argue that CSE is associated with lower failure rates and fewer adverse events than spinal or epidural anesthesia<ref name=":0">{{Cite web|title=Combined Spinal Epidural (CSE)|url=https://www.asra.com/news-publications/asra-updates/blog-landing/legacy-b-blog-posts/2019/08/07/combined-spinal-epidural-(cse)|access-date=2022-09-26|website=The American Society of Regional Anesthesia and Pain Medicine (ASRA)|language=en}}</ref>. {{Infobox surgical procedure<br />
| anesthesia_type = Regional<br />
| airway = None<br />
| lines_access = PIV<br />
| monitors = Standard, EKG<br />
| considerations_preoperative = <br />
| considerations_intraoperative = <br />
| considerations_postoperative = <br />
}}<br />
<br />
==Overview==<br />
<br />
===Indications <ref name=":0" />===<br />
<br />
* General, orthopedic, and trauma surgery of lower extremity<br />
* Urologic and gynecologic surgery<br />
* Labor analgesia - more rapid onset pain relief and lower failure rates than standard epidural<br />
* Cesarean section - rapid onset with ability to prolong anesthesia via epidural catheter<br />
<br />
===Contraindications <ref>{{Cite book|url=https://www.worldcat.org/oclc/989157369|title=Basics of anesthesia|date=2018|others=Manuel, Jr. Pardo, Ronald D. Miller, Ronald D. Preceded by: Miller|isbn=9780323401159|edition=Seventh edition|location=Philadelphia, PA|oclc=989157369}}</ref><!-- List and/or describe the contraindications for this surgical procedure. -->===<br />
Absolute contraindications<br />
<br />
*Patient refusal<br />
* Localized sepsis<br />
*Allergy to drugs used in procedure<br />
*Inability of patient to remain still for injection (risk of neurologic injury)<br />
*Increased intracranial pressure (risk of brainstem herniation)<br />
<br />
Relative contraindications<br />
<br />
*Neurologic: myelopathy or peripheral neuropathy, spinal stenosis, spine surgery, multiple sclerosis, spina bifida<br />
*Cardiac: aortic stenosis or fixed cardiac output, hypovolemia<br />
*Hematologic: thromboprophylaxis, anticoagulants, inherited coagulopathy<br />
*Infection: systemic infection, bacteremia, septic shock<br />
<br />
==Advantages of CSE==<br />
<br />
===CSE vs. Epidural Anesthesia===<br />
===CSE vs. Spinal Anesthesia===<br />
<br />
===Epidural Volume Extension (EVE)===<br />
<br />
===Use in High-Risk Patients===<br />
<br />
==Technique==<br />
<br />
===Needle-Through-Needle Technique===<br />
<br />
===Separate Needle Technique===<br />
<br />
==Drug Choices==<br />
<br />
==Risks & Complications==<br />
<br />
===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->===<br />
<br />
==References==<br />
<br />
<references /></div>Brooke.Gangwishhttps://wikianesthesia.org/w/index.php?title=Combined_spinal-epidural_anesthesia&diff=14061Combined spinal-epidural anesthesia2022-09-26T18:28:35Z<p>Brooke.Gangwish: Created general outline for CSE article.</p>
<hr />
<div>Combined spinal-epidural (CSE) anesthesia is a neuraxial technique that offers benefits of both spinal and epidural anesthesia and analgesia. The CSE technique involves a subarachnoid injection followed by the placement of a catheter in the epidural space for administration of epidural medications. This permits rapid-onset spinal analgesia, with access for supplementing insufficient subarachnoid anesthesia or prolonging anesthesia and analgesia via the epidural catheter<ref>{{Cite book|url=https://www.worldcat.org/oclc/70051351|title=Textbook of regional anesthesia and acute pain management|date=2007|publisher=McGraw-Hill, Medical Pub. Division|others=Admir Hadzic, New York School of Regional Anesthesia|isbn=0-07-144906-X|location=New York|oclc=70051351}}</ref>. Though an ongoing debate, many argue that CSE is associated with lower failure rates and fewer adverse events than spinal or epidural anesthesia<ref name=":0">{{Cite web|title=Combined Spinal Epidural (CSE)|url=https://www.asra.com/news-publications/asra-updates/blog-landing/legacy-b-blog-posts/2019/08/07/combined-spinal-epidural-(cse)|access-date=2022-09-26|website=The American Society of Regional Anesthesia and Pain Medicine (ASRA)|language=en}}</ref>. {{Infobox surgical procedure<br />
| anesthesia_type = Regional<br />
| airway = None<br />
| lines_access = PIV<br />
| monitors = Standard, EKG<br />
| considerations_preoperative = <br />
| considerations_intraoperative = <br />
| considerations_postoperative = <br />
}}<br />
<br />
==Overview==<br />
<br />
===Indications <ref name=":0" />===<br />
General surgery<br />
<br />
Labor analgesia<br />
<br />
Cesarean section<br />
<br />
Orthopedic surgery<br />
<br />
Urologic surgery<br />
<br />
===Contraindications <ref>{{Cite book|url=https://www.worldcat.org/oclc/989157369|title=Basics of anesthesia|date=2018|others=Manuel, Jr. Pardo, Ronald D. Miller, Ronald D. Preceded by: Miller|isbn=9780323401159|edition=Seventh edition|location=Philadelphia, PA|oclc=989157369}}</ref><!-- List and/or describe the contraindications for this surgical procedure. -->===<br />
Absolute contraindications<br />
<br />
*Patient refusal<br />
*Localized sepsis<br />
*Allergy to drugs used in procedure<br />
*Inability of patient to remain still for injection (risk of neurologic injury)<br />
*Increased intracranial pressure (risk of brainstem herniation)<br />
<br />
<br />
Relative contraindications<br />
<br />
*Neurologic: myelopathy or peripheral neuropathy, spinal stenosis, spine surgery, multiple sclerosis, spina bifida<br />
*Cardiac: aortic stenosis or fixed cardiac output, hypovolemia<br />
*Hematologic: thromboprophylaxis, anticoagulants, inherited coagulopathy<br />
*Infection: systemic infection, bacteremia, septic shock<br />
<br />
==Advantages of CSE==<br />
<br />
===CSE vs. Epidural Anesthesia===<br />
===CSE vs. Spinal Anesthesia===<br />
<br />
===Epidural Volume Extension (EVE)===<br />
<br />
===Use in High-Risk Patients===<br />
<br />
==Technique==<br />
<br />
===Needle-Through-Needle Technique===<br />
<br />
===Separate Needle Technique===<br />
<br />
==Drug Choices==<br />
<br />
==Risks & Complications==<br />
<br />
===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->===<br />
<br />
==References==<br />
<br />
<references /></div>Brooke.Gangwish