Practice of combined spinal and epidural anesthesia

1. The patient's position is the same lumbar anesthesia

2. Puncture point L2-3 or L3-4.

3. Puncture method

Epidural or epidural block is required for the aseptic procedure. After successful epidural puncture, a 25G lumbar puncture needle was inserted into the needle under the guidance of the epidural puncture needle, and the arachnoid membrane was punctured to exit the needle core. Cerebrospinal fluid was seen to flow out of the needle. 2-3ml local anesthetic for lumbar anesthesia was randomly injected, and the lumbar puncture needle was withdrawn. The epidural catheter was inserted through the epidural puncture needle (3cm through the needle opening). The epidural puncture needle was withdrawn, and the puncture point was covered with sterilized gauze to fix the catheter. After helping the patient turn supine, measure the block level of lumbar anesthesia. After injection of 3-5ml local anesthetic through the epidural catheter, the operation can be started without signs of high block plane after 5 minutes. During the operation, appropriate amount of local anesthetic was injected through the epidural catheter as needed to maintain anesthesia.

4. Due to the injection of light or heavy local anesthetics into the subarachnoid space, it still needs a period of time for epidural operation, which is bound to cause significant block on one side of the limb and poor on the other side and affect the whole block effect. Therefore, it is recommended to use local anesthetic with equal specific gravity when combined block.

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