Indications
This technique is suitable whenever a rapid onset of analgesia is required but the period of analgesia required exceeds that of a single spinal injection. It may be used for Caesarean sections, seeking the advantage of using a minimal dose of local anaesthetic in order to have a quicker termination of the spinal anaesthesia, but still having the catheter available in case the patient requires more than the minimal amount of medication to remain comfortable. It was hoped that this technique for caesarean section would yield greater maternal satisfaction with less hypotension and its associated nausea, but it is not clear that the technique has many advantages.
This technique also allows for post operative pain relief via epidural patient controlled anaesthesia. The epidural catheter may be left in place for up to 72 hours if required.
In labouring women, the onset of analgesia is more rapid with CSE compared with epidural analgesia. CSE in labour was formerly thought to enable women to mobilise for longer compared with epidural analgesia, but this is not supported by a recent Cochrane review.
In the UK, the National Institute for Clinical Excellence (September 2007) specifically recommends CSE for women who require rapid onset of analgesia in labour . It further recommends the use of bupivacaine and fentanyl to establish the block.
Cautions and contraindications are very similar to those for epidural anaesthesia.
Practitioners who make frequent use of the CSE technique for labour analgesia may note unexpected benefits. One example is in the event that the epidural catheter is unintentionally placed into a blood vessel. This requires removal of the catheter and its replacement. With the traditional technique of epidural placement, the patient continues in pain without relief. If the CSE technique has been used, the intrathecal injection of fentanyl results in 60 to 90 minutes of good pain relief. This creates a more pleasant environment in which to replace the errant catheter with a properly sited one.
Read more about this topic: Combined Spinal And Epidural Anaesthesia
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