Article Text

Download PDFPDF
Combined Spinal-Epidural Technique
  1. Narinder Rawal, M.D., Ph.D*,
  2. André Van Zundert, M.D., Ph.D,
  3. Björn Holmström, M.D., Ph.D and
  4. John A. Crowhurst, D(Obst.)RCOG, FANZCA§
  1. *Department of Anesthesiology and Intensive Care, Örebro Medical Center Hospital, Sweden
  2. the Department of Anesthesiology, Catharina Hospital, the Netherlands
  3. Department of Anesthesiology and Intensive Care, Lindesberg Hospital, Sweden
  4. §Department of Anaesthesia, Queen Charlotte's & Chelsea Hospital, United Kingdom
  1. Reprint requests: Dr. Björn Holmström, M.D., Ph.D., Department of Anesthesiology and Intensive Care, Lindesberg Hospital, S-711 82 Lindesberg, Sweden.


Background For the past 16 years the combined spinal-epidural (CSE) technique has been extensively researched and developed to the point where it is now in widespread use. Along with the use of low-dose mixtures of local anesthetics and opioids, and the introduction of fine-gauge pencil-point needles, CSE is being increasingly recognized as another important addition to the armamentarium of the anesthesiologist.

Method One hundred and forty-two publications focusing on the CSE technique, or on questions concerning CSE-related issues, were reviewed. Out of 33 double-blind or controlled studies, 23 directly investigated the CSE technique. Fifty-four prospective studies and letters made directly relevant points on advantages or problems with CSE. Twenty-one book chapters, reviews and editorials were included, 11 of them concerning the use of CSE technique.

Results All CSE techniques which may be used for surgical anesthesia, for analgesia in labor or for postoperative pain management are described. Indications, advantages, disadvantages, and the various methods for performing CSE procedures, including sequential CSE block, are described and reviewed, along with the equipment currently available for their administration.

Conclusion The CSE technique offers many potential advantages over continuous epidural or subarachnoid methods alone, including a reduction in drug dosage, the ability to eliminate motor blockade and to achieve highly selective sensory blockade and optimize analgesia. These features hold great promise for minimizing the hazards and side effects of traditional epidural and subarachnoid techniques. Controversial fears, risks, and pitfalls of the CSE technique and of continuous epidural and subarachnoid methods are debated and discussed.

  • combined spinal-epidural anesthesia
  • epidural anesthesia
  • spinal anesthesia
  • postdural puncture headache
  • epidural opioids
  • spinal opioids

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.