Background:There are several theories to explain the action of local anesthetic in combined spinal-epidural anesthesia (CSE), this study is to examine a technique of (CSE) that depends on the theory of leakage of epidural drugs to the subarachnoid cerebrospinal fluid (CSF). Patients and Methods:After approval of local medical ethics committee and obtaining informed consent, 60 patients (18-80 years, ASA physical status I to IV) who listed for orthopedic lower limb surgery under CSE were included in this study. The study design was prospective Cross-Section comparative one. It was done in Gulan General Hospital and Gian Private Hospital in Duhok Governorate in Kurdistan Region of Iraq in the period from 01/01/2017 to 28/2/2018. Results:the volume needed to get maximum sensory block (MSB) and the frequency of topup doses are greater in group A than B.The onset time of group A is longer than group B. The mean arterial pressure was much stable in group A with less nausea and vomiting in the same group. Addition, more patients in group A than group B were able to move against gravity. Conclusions:the effect of this technique in combined spinal-epidural anesthesia can be compared to that of separate needle with more stable vital signs and less complications but with more allover doses of local anesthetics. Duhok Med J 2019; 13 (1):9-21.

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