Continuous spinal anaesthesia

Continuous spinal anaesthesia and analgesia for emergency caesarean section in a patient with severe kyphoscoliosis and acute lower respiratory tract infection

“…4,5,6 Other factors which may contribute to cauda equina syndrome 4 are using large volumes of heavy bupivacaine (> 3 cc) 6 caudally placed catheters of > 3 cm and use of lignocaine. 6 Most commercially available epidural kits including 17G or 18G Tuohy-type needle, can be used for dural puncture and placement of the catheter in the subarachnoid space. 4 An advantage of using such catheters is the ease with which CSF can be withdrawn, confirming the correct placement of the catheter.…”

“…Same size catheter as the needle is thought to reduce the CSF leak as it fits well in to the dural hole. 6 We turned the bevelled end downwards which facilitated catheter advancement in caudal direction as a safety precaution to prevent high spread.…”

“…Plain bupivacaine is the usual drug of choice in continuous spinal anaesthesia. 6 The epidural catheter and filter has 1 ml of dead space; therefore it is advised that a continuous spinal catheter be flushed with 1ml of saline after each bolus dose. 4 However one must take care in doing this to avoid injecting large volumes of saline intrathecally.…”

Anaesthesia for lower-segment caesarean section: Changing perspectives

“…The apparent high risk of post-dural puncture headache had led to the development of microcatheters, which were unfortunately associated with kinking and breakage. [ 27 28 ] In the early 1990s, the Food and Drug Authority in the United States banned the use of catheters finer than 24 G due to its possible association with cauda equina syndrome. [ 29 ] Nowadays, with the use of newer spinal catheters that have smaller gauges, the interest in this controversial form of regional technique has increased.…”