Combined Spinal-Epidural Anaesthesia for Lower Limb Orthopaedic Surgery-An Observational Study
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Abstract
Background: Combined spinal-epidural (CSE) anaesthesia has emerged as a preferred technique for major orthopaedic procedures. This study evaluates the effect of epidural top-up on spinal anaesthesia using the separate interspace method in total knee replacement surgeries. Material and Methods: A prospective observational study was conducted on 66 patients undergoing elective TKR. Sensory and motor blockade, haemodynamic changes, and postoperative analgesia were analysed across the spinal and epidural phases. Results: Epidural top-up significantly increased sensory blockade in 77.2% of patients. Motor blockade was sustained, and haemodynamic parameters remained stable. VAS scores remained low postoperatively, indicating effective pain control. Conclusion: The separate interspace CSE technique enhances sensory blockade, provides stable intraoperative conditions, and ensures effective postoperative analgesia, validating its use in prolonged orthopaedic procedures.
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Copyright (c) 2025 Dr Ritika Negi, Dr Harshalata Arvind Suryawanshi , Dr Fatema Kutbuddin Mujpurwala, Dr. Ratan Gupta
This work is licensed under a Creative Commons Attribution 4.0 International License.
Creative Commons License All articles published in Annals of Medicine and Medical Sciences are licensed under a Creative Commons Attribution 4.0 International License.
Dr Ritika Negi, Associate Professor, Department of Anaesthesiology, MGM Medical College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India
Associate Professor, Department of Anaesthesiology, MGM Medical College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India
Dr Harshalata Arvind Suryawanshi , Assistant Professor, Department of Anaesthesiology, MGM Medical College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India.
Assistant Professor, Department of Anaesthesiology, MGM Medical College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India.
Dr Fatema Kutbuddin Mujpurwala, Assistant Professor, Department of Anaesthesiology, MGM Medical College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India.
Assistant Professor, Department of Anaesthesiology, MGM Medical College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India.
Dr. Ratan Gupta, Senior Consultant, Department of Cardiothoracic Intensive Care, Narayana Health Bengaluru, Karnataka, India
Senior Consultant, Department of Cardiothoracic Intensive Care, Narayana Health Bengaluru, Karnataka, India
[1] Greene NM. Distribution of local anesthetic solutions within the subarachnoid space. Anesth Analg. 1985;64(7):715-30.
[2] Cousins MJ, Bridenbaugh PO. Neural blockade in clinical anesthesia and management of pain. 3rd ed. Lippincott-Raven; 1998.
[3] Curelaru I. Subarachnoid and epidural anesthesia: Long-term experience with combined techniques. Anesth Analg. 1980;59(7):439-46.
[4] Rawal N. Combined spinal-epidural anesthesia. Curr Opin Anaesthesiol. 1998;11(5):519-21.
[5] Becker DE, Reed KL. Local anesthetics: Review of pharmacological considerations. Anesth Prog. 2012;59(2):90-101.
[6] Liu SS, Strodtbeck WM, Richman JM, Wu CL. A comparison of regional versus general anesthesia for total hip arthroplasty: A meta-analysis. Anesth Analg. 2005;101(6):1638-45.
[7] Danninger T, Memtsoudis SG. Tranexamic acid and neuraxial anesthesia in joint arthroplasty: A review. Anesth Analg. 2014;118(2):202-8.
[8] Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: Results from overview of randomised trials. BMJ. 2000;321(7275):1493.
[9] Brown DL. Spinal, epidural, and caudal anesthesia. In: Miller’s Anesthesia. 7th ed. Philadelphia: Churchill Livingstone; 2010.
[10] Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet. 2003;362(9399):1921-8.
[11] Matsushita T, Yamada Y, Inoue S, Tanaka Y. Enhancement of spinal block by epidural top-up: Pharmacokinetic and pharmacodynamic perspectives. J Anesth. 2020;34(5):726-32.
[12] Narayanasamy S, Vasanthakumar K, Kumari SA. Comparative evaluation of motor blockade in separate vs same interspace CSE technique in lower limb surgeries. Indian J Anaesth. 2021;65(3):212-8.
[13] Hartmann B, Junger A, Klasen J, Benson M, Jost A, Banzhaf A, et al. The incidence and risk factors for hypotension after spinal anesthesia induction: A meta-analysis. Anaesthesia. 2020;75(8):1064-73.
[14] Talke P, Tayefeh F, Sessler DI, Jeffrey R, Noursalehi M, Richardson C. Effects of epidural anesthesia on thermoregulatory responses. Anesthesiology. 2022;136(2):230-40.
[15] Aasen AO, Myhre HO, Soreide E. Complications related to combined spinal-epidural anaesthesia: A review of 5,000 cases. Acta Anaesthesiol Scand. 2019;63(6):745-52.