Combined spinal-epidural (CSE)‏

It is important to appreciate the option of combined spinal-epidural (CSE). In CSE, both techniques are used simultaneously. The spinal can provide rapid onset anaesthesia, although a decreased initial dose can be used if clinically indicated. The epidural can then be used to increase the level of block, to prolong the duration of anaesthesia, and then for post-operative analgesia.

Benefits of CSE include:

• Allows gradual establishment of neuraxial block in patients with fixed cardiac output disease
• Facilitates neuraxial anaesthesia for surgery where:
  • duration is uncertain
  • post-operative pain likely to be moderate to severe

There are various techniques for performing this type of block.