Combined spinal-epidural anesthesia practice specification

Operation specification for combined spinal anesthesia and epidural block 1. Patient position is the same as spinal anesthesia

2. Puncture point L2-3 or L3-4.

3. Puncture method

Aseptic operation requires the same as spinal anesthesia or epidural block. After successful epidural puncture, a 25G lumbar puncture needle was inserted into the needle with the epidural needle as the guide, passed through the epidural needle port, punctured the arachnoid, and withdrawn from the needle core, and the cerebrospinal fluid was seen flowing out of the needle. Randomly inject 2-3ml of local anesthetic for spinal anesthesia, withdraw from the lumbar puncture needle, insert an epidural catheter through the epidural needle (3cm through the needle port), withdraw from the epidural puncture needle, cover the puncture point with sterile gauze, and fix the catheter . After helping the patient to turn over to lie on his back, measure the level of spinal anesthesia block. Inject 3-5ml of local anesthetic through the epidural catheter. After 5 minutes, there is no sign of high block level, and the operation can be started. During the operation, an appropriate amount of local anesthesia was injected through the epidural catheter as needed to maintain anesthesia.

4. After the light or heavy specific gravity local anesthetic is injected into the subarachnoid space, it will take a period of time to perform epidural operation, which will inevitably make one side of the limb block significantly worse than the other side and affect the overall block effect. Therefore, it is often advocated that equal specific gravity local anesthesia should be used for spinal anesthesia during combined block.

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