Vojnosanitetski pregled 2013 Volume 70, Issue 10, Pages: 953-958
https://doi.org/10.2298/VSP1310953S
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Combined spinal-epidural technique: Single-space vs double distant space technique
Slavković Zoran (Military Medical Academy, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade)
Stamenković Dušica M. (Military Medical Academy, Belgrade)
Gerić Veselin (Medical Center “Bežanijska Kosa”, Belgrade)
Veljović Milić (Military Medical Academy, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade)
Ivanović Nebojša (Medical Center “Bežanijska Kosa”, Belgrade)
Todorović Slobodan (Medical Center “Bežanijska Kosa”, Belgrade)
Marić Predrag (Military Medical Academy, Belgrade)
Karanikolas Menelaos (Washington University School of Medicine, Department of Anesthesiology, Washington, USA)
Background/Aim. Several combined spinal-epidural (CSE) anesthesia techniques
have been described. This study was designed to compare the single space
(“needle-throughneedle”) technique (SST) and the double distant space
technique (DDS) with regards to the time needed for the procedure, patient
discomfort during the procedure and patient's preference technique. Methods.
This prospective, randomized single-blind study included 156 patients
undergoing colorectal surgery under general anesthesia and CSE. All neuraxial
blocks were performed before general anesthesia induction. DDS group of
patients had thoracic epidural catheter placed at T6-7 or T7-8, followed by
subarachnoid injection at the L2-3 interspace. The SST group of patients had
a single injection using the needle-through-needle technique (Espocan®
needle) at L2-3. The epidural catheter was used for postoperative analgesia
for 72 hours. Body habitus, spinal anatomy and spinal landmarks were assessed
preoperatively. The number of epidural and spinal punctures, the feeling that
the dura is perforated (dural perforation click) and the time needed to
perform CSE were also recorded. Complications during epidural catheter
placement and perioperative and postoperative epidural catheter function and
patient preference for the anesthetic procedure were recorded. Results.
Epidural and subarachnoid spaces were successfully identified in all the
patients. Duration of CSE procedure, the number of spinal punctures, dural
click feeling and the effects of test dose did not differ between the groups.
The patients in both groups (90% of DDS and 87% of SST) would choose CSE as
preferred method in the future. The CSE procedure was painful for 16% of DDS
vs 20% of SST patients. A significant correlation between time needed for CSE
technique performance and body habitus (r = 0.338, p < 0.01), spinal
landmarks (r = 0.452, p < 0.001) and anatomy (r = 0.265, p < 0.05) was found
in the SST group. There was no correlation between the number of
epidural/spinal punctures and epidural bacteriological findings. There was no
correlation between the patients’ choice of the CSE technique and the number
of spinal punctures, duration of CSE procedure and epidural catheter stay.
Conclusion. The two CSE techniques did not differ with regards to the
procedure time and patient's preference. Procedure time correlated with body
habitus, spinal landmarks and the anatomy in the SST group.
Keywords: anesthesia, epidural, anesthesia, spinal, colorectal surgery, anesthesia, general