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A clinical comparison between single-space technique and double-space technique for combined spinal and epidural anesthesia


1 Department of Anaesthesia, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
2 Department of Anaesthesia, East Point College of Medical Sciences, Bengaluru, Karnataka, India
3 Department of Anaesthesia, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
4 Department of Anaesthesia, MVJ Medical College and Research Hospital, Bengaluru, Karnataka, India
5 Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India

Correspondence Address:
Shailesh Kumar,
Department of Anaesthesia, MVJ Medical College and Research Hospital, Bengaluru - 562 114, Karnataka
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aer.aer_19_22

Background: Combined spinal and epidural anesthesia (CSEA) is commonly performed by double space technique (DST) and single space segment technique (SST) or needle-through-needle technique (NNT). Aims and Objectives: We designed a double-blind randomized controlled study to compare the effect of the double-space technique with that of the single-space technique on time required by the procedure, the number of attempts, and a level of sensory, side effects and cost-effectiveness. Materials and Methods: Patients undergoing elective lower abdominal and lower limb surgeries under regional anesthesia were randomized to receive CSEA with either the double-space technique (double group, n = 30) or the single-space technique (single group, n = 30). In the single group, the procedure was performed at the L3-4 interspace using the needle-through-needle technique. In the double group, an epidural catheter was inserted at the L1–2 interspace, and dural puncture was performed at the L3–4 interspace. Results: The single space (needle-through-needle) technique for CSE takes less time, less number of spinal punctures. There was no difference between the two groups in terms of side effects. Sensory level at T10 on 5 min in group I was 90% and group II was 100% whereas at T8 it was 10% in group I; sensory level at T10, T8 and T6 on 10 min. in group I were 53.3%, 43.3% and 3.3% respectively whereas in group II were 80%, 16.7% and 3.3% respectively; sensory level at T10, T8, T6 and T4 on 15 min. in group I were 6.7%, 43.3%, 50% and 0% respectively whereas in group II were 23.3%, 50%, 23.3% and 3.3% respectively; and sensory level at T4, T6 and T8 on 20 min. in group I were 0%, 73.3% and 26.7% respectively whereas in group II were 16.7%, 33.3% and 50% respectively. Conclusions: Single-space (needle-through-needle) CSEA takes less time, less number of spinal punctures and results in improved patient satisfaction. There were no differences in intraoperative variables between the DST and SST for CSEA.


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