Insertion Technique
Combined spinal-epidural anaesthesia is a highly specialised technique which should only be administered by a properly trained anaesthetic practitioner working with full aseptic technique.
The needle-through-needle technique involves the introduction of a Tuohy needle (epidural needle) into the epidural space. The standard technique of loss of resistance to injection may be employed.
A long fine spinal needle (25G) is then introduced via the lumen of the epidural needle and through the dura mater, into the subarachnoid space. A small pop is felt as the dura is punctured, and the correct position is confirmed when cerebrospinal fluid can be seen dripping from the spinal needle.
A small dose of local anaesthetic (e.g. bupivacaine) is then instilled. An opioid such as fentanyl may also be given if desired. The spinal needle is then withdrawn and the epidural catheter inserted in the standard manner.
Alternatively, a two-level approach may be undertaken. The epidural space is first located in the standard manner. Then, at another level, a standard spinal is performed. Finally, the epidural catheter is threaded through the Tuohy needle.
Read more about this topic: Combined Spinal And Epidural Anaesthesia
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