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A Clinical Comparison Between Needle-Through-Needle and Double-Segment Techniques for Combined Spinal and Epidural Anesthesia
  1. A. Casati, M.D.*,
  2. A. D'Ambrosio, M.D.,
  3. P. De Negri, M.D.,
  4. G. Fanelli, M.D.*,
  5. V. Tagariello, M.D. and
  6. F. Tarantino, M.D.*
  1. *From the Department of Anesthesiology, University of Milan, IRCCS H San Raffaele, Milano, Italy; the
  2. Department of Anesthesiology, IRCCS H Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy; and the
  3. Department of Anesthesiology, Centro Traumatologico Ortopedico, Rome, Italy.
  1. Reprint requests: Andrea Casati, M.D., Department of Anesthesiology, IRCCS H San Raffaele, via Olgettina 60, 20132 Milan, Italy.


Background and Objectives The goal of the present investigation was to compare the double-segment and the needle-through-needle techniques for combined spinal and epidural anesthesia (CSE) in a prospective, randomized, blinded study.

Methods With Ethical Committee approval and patient's consent, 120 patients were randomized to receive CSE by the needle-through-needle (SST; n = 60) or the double-segment technique (DST; n = 60). A blind observer measured the time required from skin disinfection to readiness for surgery (loss of pinprick sensation up to T10), failure of dural puncture, need for epidural top-up before surgery, patient acceptance, and occurrence of complications.

Results No neurologic complications were observed in either group. Time to readiness for surgery was 22.7 ± 8.2 minutes in the SST group and 29.8 ± 8.31 minutes in the DST one (P < .001). Dural puncture was unsuccessful in three patients in the SST group (5%) and in one patient in the DST group (1.6%) (ns); inadequate spread of spinal anesthesia was observed in five patients in the SST group (8.3%) and in eight patients in the DST group (13.3%) (ns). No difference in the incidence of hypotension, postdural puncture headache, and back pain was observed between the two groups. Acceptance of anesthetic procedure was better in the SST (85%) than in the DST group (66.6%) (P < .05).

Conclusions The needle-through-needle technique for CSE requires less time, has no greater failure rate, and results in greater patient satisfaction than the double-segment technique. The use of a spinal needle with an adjustable locking mechanism and protruding up to 15 mm beyond the Tuohy needle improved successful spinal block in the needle-through-needle technique compared with previous reports.

  • regional anesthesia
  • spinal anesthesia
  • epidural anesthesia.

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