Combined spinal and epidural anaesthesia

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Combined spinal and epidural anaesthesia or analgesia is a regional anaesthetic technique.

It has the benefits of both spinal anaesthesia and epidural anaesthesia. The spinal component gives a rapid onset of a predictable block. The indwelling epidural catheter gives the ability to provide long lasting analgesia and to titrate the dose given to the desired effect.

The needle-through-needle technique involves the introduction of a large-bore (16G or 18G) epidural needle into the epidural space. A long fine spinal needle (25G) is then introduced via the lumen of the epidural needle and through the dura, into the subdural space. A small pop is felt as the dura is punctured, and the correct position is confirmed when spinal fluid can be aspirated from the spinal needle. A small quantity of local anaesthetic and an opioid such as fentanyl, is then injected; the spinal needle withdrawn and the epidural catheter inserted.

This technique is suitable whenever a rapid onset of analgesia is required but the period of analgesia required exceeds that of a single spinal injection. It is commonly used for Caesarean sections.

This technique shares the contraindications and complications of both procedures.