Continuous Spinal Anesthesia versus Combined Spinal Epidural Anesthesia for Major Orthopedic Hip Surgeries

Abstract

C ontinuous 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.