الفهرس 
IntroductionOnly 14 pages are availabe for public view
Abstract
Continuous spinal anesthesia is the technique of producing and maintaining spinal anesthesia with small doses of local anesthetic which are injected intermittently into the subarachnoid space via an indwelling catheter. It is considered a longstanding anesthetic technique that could be used for surgery of the lower limbs and lower abdomen. It is an underutilized technique in modern anesthesia practice. Compared with other techniques of neuraxial anesthesia as single-dose spinal anesthesia and continuous epidural anesthesia, it has shown several advantages such as administration of local anesthetics in small incremental doses titrated to the individual patient’s needs, reduced requirements of local anesthetics and thus decreased systemic toxic effects, ensured cardiovascular stability, and extended anesthesia by supplemental application of spinal local analgesics when surgery is unexpectedly extended.
The combined spinal–epidural technique (CSE) can be defined as the intentional injection of drug into the subarachnoid space and the placement of a catheter into the epidural space as part of the same procedure. This technique combines the rapidity, density, and reliability of the subarachnoid block with the flexibility of continuous epidural block to extend duration of analgesia.
CSE is currently popular and it is used in a wide variety of clinical settings, including general surgery, vascular surgery, urology, orthopedic surgery, obstetrics and gynecology and pediatric surgery. CSE seems to be particularly useful in ambulatory surgery, because it facilitates early patient ambulation and discharge to home. In addition, CSE probably has a role in patients with significant comorbidities, who need to undergo surgery and are considered at high risk for general anesthesia.
This prospective randomized clinical trial study was aimed at comparing the efficacy of continuous spinal anesthesia technique versus combined spinal epidural technique in Major hip surgeries and potential complication for both techniques.
This study was conducted at Ain Shams University Hospitals at the orthopedics operating theatre on 72 patients aged more than 30 years, of both sexes and American Society of Anesthesiologists (ASA) class I, II, scheduled for elective hip surgeries. All Patients were assigned randomly by using a computerized program to one of two equal groups; group(CSA) patients undergoing elective hip surgery which received continuous spinal anesthesia, and another group (CSE)which received combined spinal epidural anesthesia.Each group 36 patients and after exclusion of the failed cases,group(CSA)was 34 patients while group(CSE)was 32patients.
The exclusion criteria was Patient refusal, Advanced cardiac diseases, Coagulation disorder and bleeding tendency, Infection at puncture side, Altered mental state, Severe deformity of the spinal column, Any contraindication to regional block, Allergy to any of the test drugs.
The study recorded the following: Demographic characteristics such as age, sex, body mass index, the failure rate, the perioperative hemodynamics parameters including heart rate, mean arterial blood pressures, the onset and level of sensory blockade, degree of motor blockade, assessment of block satisfaction by the patients and surgeons, the anesthetic complications such as post dural puncture headache, the total dose of local anesthetics that was given intra operatively and the time of first request to analgesia in both groups.
The patient groups were comparable as regarding age, sex and BMI with no statistical significance. Heart rate was significantly higher in group CSE than group CSA at 5 and 15 minute and mean blood pressure values were significantly lower in group CSE than group CSA at 5and 15 minute. Failure rate was higher in CSE group. Level of sensory block was higher in CSE group with no difference in onset of sensory block, degree of motor block, assessment of block satisfaction by patients and surgeons and time of first request for analgesia after removal of the catheter. PDPH was higher in group CSA than group CSE and the total dose of bupivacaine was significantly lower in group CSA than group CSE.
This study revealed that CSA technique provides a good anesthetic profile using smaller anesthetic dose with rapid onset and recovery of motor and sensory blockade with better cardiovascular stability and low failure rate than CSE