What are the advantages and disadvantages of spinal anesthesia, epidural anesthesia, and combined spinal and epidural anesthesia

Spinal anesthesia has quick onset, exact effect and short duration of action. The epidural has a slow onset of action, and the effect is sometimes imprecise. The stiffness of the waist makes up for the lack of lumbar numbness.

Combined spinal-epidural anesthesia uses the characteristics of spinal anesthesia and epidural anesthesia to improve the anesthesia effect and increase the technical level of operation. It carries forward the advantages and strengths of the two, and makes up for the shortcomings and deficiencies of the two.

Advantages and advantages of combined epidural anesthesia:

Rapid onset of action; exact effect; unlimited anesthesia time; small amount of local anesthetic; low incidence of local anesthetic poisoning; postoperative epidural analgesia; true spinal anesthesia "non-contact" technique.

The disadvantages of combined spinal-epidural anesthesia are:

(1) The scope of the operation is limited to the lower body (restricted by the highest safety puncture point);

(2) Because of the superposition of the two anesthesia methods, the disturbance to the patient will also increase, so the medication needs to be more careful;

(3) "Complications" may occur after the application of both anesthesia methods;

(4) The effect and scope of anesthesia will not always remain the same as at the beginning (it will be more like epidural anesthesia).

(5) The block range of CSEA is wider than that of general spinal anesthesia or epidural block. The reasons are as follows:

①The local anesthetic in the epidural space penetrates into the subarachnoid space through the damaged part of the dura;

②The pressure in the epidural space changes and the negative pressure disappears, which promotes the diffusion of the local anesthetic in the cerebrospinal fluid;

③ The local anesthetic liquid is injected into the epidural space, the volume increases, and the dura mater is squeezed to increase the pressure of the lumbosacral subarachnoid space, which promotes the diffusion of the local anesthetic to the head, and the block level can be increased by 3 to 4 segments. part;

④The cerebrospinal fluid overflows from the dural pinhole, diluting the local anesthetic in the epidural space, increasing the volume and raising the block level;

⑤ The local anesthetic spreads upward in the subarachnoid space due to postural changes;

⑥ In order to remedy the insufficient level of spinal anesthesia, local anesthesia was blindly injected through the epidural catheter. Therefore, during CSEA, anesthesia management should be strengthened, local anesthetics should be used rationally, vital signs should be closely monitored, blood volume replenishment should be accelerated when necessary, and vasopressors should be appropriately used.

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