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Połączone znieczulenie podpajęczynówkowe i zewnątrzoponowe – 25 lat praktyki klinicznej
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For the past 25 years the combined spinal-epidural (CSE) technique has been widely used in our clinical practice and extensively researched and developed. Along with the use of low-dose mixtures of local anesthetics and opioids, the introduction of fine-gauge pencil-point needles, CSE is increasingly recognized as a further improvement of either spinal and epidural anesthesia techniques. Both spinal and epidural anesthesia techniques are major anesthetic techniques, which have potential advantages over general anesthesia. Spinal anesthesia is practiced very widely due to its simplicity of administration, fast onset of action, producing a reliable and solid block without toxicity as only small doses of local anesthetics are used. The presence of cerebrospinal fluid as endpoint allows for a more certain outcome than epidural anesthesia. Epidural anesthesia on the other hand is chosen as it results in a less dense block. It causes less hypotension than spinal anesthesia, and if correctly performed, does not result in postdural puncture headache. The CSE technique offers us the best of both techniques, with the reliability of a spinal block and the flexibility of an epidural catheter, resulting in a reduction of drug dosage, the ability to eliminate motor block and the achievement of a highly selective sensory block and optimal analgesia. Although the CSE technique has become very popular, it is a more complex technique that requires comprehensive understanding of two techniques, i.e. spinal and epidural physiology and pharmacology. The CSE technique is not for the novice in anesthesia. It requires extensive experience in both techniques, before one should attempt the CSE technique. Although the CSE technique refines either spinal or epidural technique to the best interest of our patients, it has a potential for higher failure rates than with each individual techniques.
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