Background and Aims Continuous spinal anaesthesia (CSA) is used particularly in orthopedics and for large-scale tumor operations. The advantage of this technique is immediate pain relief and anesthetic block achievement with a minimum anaesthetic amount. We present a case with our first experience with CSA.
Methods A 58 y, 63kg BW, 1.74m HT man was admitted for intramedullary nailing of an intertrochanteric right femoral fracture. His medical history comprised chronic opioid addiction, currently in a substitution program with methadone. He was also suffering diabetes mellitus type II, under insulin. Hepatitis Virus C positive and with METs < 4, his medication comprised escitalopram, aspirin and LMWH. His labs were: Hgb 8.8 g/dL, Hct 26.7%, PLTs 296000, PT 10.7 sec, APTT 35 sec and INR 1.0 and he was free from thromboprophylaxis the last 24 hrs. A 22G 90 mm atraumatic intrathecal cannula (Intralong®, Sprotte®, Pajunk, Geisingen, Germany) was used for dura matter puncture in the L3–4 intervertebral space. After successful CSF leak at 6.5cm from skin, a 27G, 90cm intrathecal catheter was inserted and secured at 11 cm from skin. 2 ml 0.5% levobupivacaine was infused through an insulin syringe with 0.2 ml (10mcg) fentanyl and 0.2 ml (30 mcg) clonidine as adjuvants.
Results Immediate anesthetic level at T3 was achieved. No further dose was needed. Surgery lasted 1.5 h. The catheter was removed at the end of the procedure. The anaesthetic block lasted 3h. No post puncture headache was noted.
Conclusions CSA is a promising and efficient technique providing excellent operational conditions.