Combined Spinal-Epidural Anesthesia in Orthopedics

Boonsong P.,M.D.,Seethanawiboonchai P.,M.D.*,Suntikulanon U.,M.D.*,Khunsongkiet P.,M.D.

Department of Anesthesiology, Faculty of Medicine, Chiangmai University, Chiangmai 50200

* Resident,Department of Anesthesiology, Faculty of Medicine, Chiangmai University, Chiangmai 50200

  The authors used the combined spinal-epidural technique (CSE) in 20 patients undergoing orthopedic surgery. Four ml of 0.5% heavy bupivacaine and 3 mg of morphine were injected into subarachnoid and epidural space respectively. Satisfactory surgical conditions were obtained in every patient with median height of block at T4 (range T3-T7) and median duration of block of 225 minutes (range 185-270 minutes) whereas in 15 patients median duration of postoperative analgesia was 19.14 hours (range 9.46-21.17 hours) and others have postoperative analgesia more than 24 hours. Hypotension occurred in 8 patients (40%),however responded well to fluids and ephedrine. Other side effects included nausea (10%),vomiting (5%) and pruritus (15%). No respiratory center depression was noted up to 24 hours postoperatively. The results from this preliminary study suggested that this technique could be used in orthopedic patients with good surgical conditions and long postoperative pain relief.