Continuous Spinal Anesthesia Versus Combined Spinal Epidural Block

Continuous Spinal Anesthesia Versus Combined Spinal Epidural Block for Major Orthopedic Surgeries. Study Prospective and Randomized.

In major orthopaedic surgery of the lower extremities both continuous spinal anesthesia (CSA) and combined spinal epidural anesthesia (CSE) are safe and reliable anaesthesia methods. Our results suggest that both continuous spinal anesthesia and combined spinal epidural anesthesia provide good surgical conditions with a low incidence of complications. The sensory block level and hemodynamic changes were lesser with CSA.

240 patients scheduled for hip, knee arthroplasty or fracture of the femur were randomly assigned to receive either CSA or CSE. Blocks were performed in the lateral position at L3-L4 interspace. Puncture success, technical difficulties, paresthesia, highest level of sensory and motor block, need for complementary doses of local anesthetic, degree of technical difficulties, cardiocirculatory changes and post dural puncture headache were registered. At the end of the surgery, the catheter was removed and CSF leak was evaluated.

Inclusion Criteria:

• Fractures repair of femur, or arthroplasty of either knee or hip

Exclusion Criteria:

• Hypovolemia
• Preexisting neurologic disease
• Coagulation disorders and/or administration of thromboprophylaxis less than eight hours before the start of surgery
• Infection at the puncture site
• Agitation or delirium and the presence of a urinary bladder catheter.