In recent years, regional anesthesia techniques for surgery, obstetrics, and postoperative pain management have been used with increasing frequency.(1–3) The combined spinal-epidural (CSE) technique, a comparatively new anesthetic choice, includes an initial subarachnoid injection followed by epidural catheter placement and subsequent administration of epidural medications. This allows for rapid relief of pain or induction of regional anesthesia by the rapid onset of the spinal drugs and subsequent administration of medications for prolonged anesthesia. In addition, postoperative analgesia via the epidural catheter can be delivered for extended periods.
Clinical studies have demonstrated that the CSE technique provides excellent surgical conditions as quickly as the singleshot subarachnoid block and with advantages in comparison to the conventional epidural block. The advantage lies in the fact that CSE anesthesia offers benefits of both spinal and epidural anesthesia.
Although the CSE technique has become increasingly popular over the past two decades, it is a more complex technique that requires comprehensive understanding of epidural and spinal physiology and pharmacology.
This chapter discusses the technical aspects, advantages, potential complications, and limitations of the CSE technique for surgery, postoperative pain management, and labor analgesia.
Most women experience moderate to severe pain during labor and delivery, often requiring some form of pharmacologic analgesia.(1) The lack of proper psychological preparation combined with fear and anxiety can greatly enhance the patient’s sensitivity to pain and further add to the discomfort during labor and delivery. However, skillfully conducted obstetric analgesia, in addition to relieving pain and anxiety, may benefit the mother in many other ways. This chapter focuses on the management of obstetric patients with a primary focus on regional anesthesia techniques.