Combined Spinal Epidural (CSE)
Rhashedah A. Ekeoduru, M.D.
Rohit Y. Rahangdale, M.D.
Department of Anesthesiology
Northwestern University Feinberg School of Medicine
Soresi first described the benefits of injecting anesthetics through a needle (not a catheter) both in the subarachoid and epidural spaces in 1937.1 The first documented combined spinal epidural (CSE) procedure with placement of an epidural catheter was performed in 1979 by Curelaru, using the separate needle technique.2 Today CSE is commonly used for obstetric, gynecologic, orthopedic, urologic and general surgery anesthesia.
Combined spinal epidural anesthesia plays a valuable role in the armamentarium of anesthesiologists by offering many of the advantages of spinal and epidural anesthesia while minimizing the risks associated with each technique.3 Proper use of this technique requires an intimate understanding of the interrelationship of the epidural space, its contents, and the thecal sac. Additionally, one must pay attention to the potential complications, technical aspects, and limitations of the procedure.
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