Updates in Continuous Spinal Anesthesia

Abstract

CSA is a technique which has marked advantages in certain clinical circumstances, particularly patients undergoing lower body surgery who are old in age and/or have co-morbidities such as in the lungs (as COPD) and/or in the cardiovascular system (as severe valvular heart lesions) who can benefit from avoiding the risks of endotracheal intubation and general anesthesia and in the same time avoiding rough hemodynamic changes associated with other types of neuraxial blocks. CSA is effective for intra-operative anesthesia as well asfor post-operative analgesia, and also the intrathecal catheter can be used for long term intrathecal drug administration to control chronic pain or spasticity. Catheters used can be a micro-catheter (<24G) or a macro-catheter (>24G), the micro-catheter allow using smaller spinal needles thus decreasing the incidence of PDPH, but it present more technical difficulties. It can be inserted in a catheter-over-the needle or a needle-over-the catheter fashion according to the CSA set used, catheter-over-the needle type (Spinocath®) can decrease duration and severity of PDPH by decreasing CSF leak from around the catheter.