Abstract
Background & Aim: The combined spinal epidural technique (CSE) involves subarachnoid blockade and epidural catheter placement in procedure. Aim was to compare two different approaches of CSE, paramedian epidural with midline Subarachnoid block, that is Single space dual needle technique (SDT) with the Single space technique (SST).
Materials and Methods: The study was randomised, comparative &prospective. A total of 80 patients were divided in Group I SST & Group II SDT. Inclusion criteria: ASA grade I/II, undergoing Hysterectomy etc. Exclusion criteria: Patient refusal, allergy, coagulopathy, IHD, local infection etc. Group I- Needle through needle technique. Group II-Epidural in paramedian position with midline spinal. Parameters observed were technique performance time, time to surgical readiness, in Epidural block: attempts for space localisation, accidental dural puncture. For epidural catheter: attempts for insertion, presence of blood / CSF, paraesthesia, inability to push test dose. While Subarachnoid block; attempts, appreciation of dural puncture, reflux of CSF < 5 seconds.
Results: Both were comparable in technique performance time & time to surgical readiness. Parameters relating to epidural block were comparable.The appreciation of dura in SAB in group I was 26 and group II was 39(p 0.0002) which was statistically significant. The incidence of reflux of CSF within 5 seconds in the group I was 33 and group II was 40 which was statistically significant (p 0.0056).
Conclusion: Paramedian epidural with midline spinal at the same space is an acceptable alternative to the Single Space technique.
Keywords: Paramedian, Epidural, Spinal, Midline.
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Corresponding Author
Manish Anand
Consultant, Heart Hospital, Kankerbagh, Patna, Bihar, India
DOI: https://dx.doi.org/10.18535/jmscr/v7i5.146
