• HAIDAR N. MOHAMMED Department of anesthesia, College of Health Sciences, University of Duhok, Kurdistan Region, Iraq
  • WAHID M. HASSAN Assistant professor, Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region
Keywords: Combined Spinal-Epidural Anesthesia;, Leakage of local anesthetics;, and Spinal needle stylet through Tuohy needle


Background:There are several theories to explain the action of local anesthetic in combined spinal-epidural anesthesia (CSE), this study is to examine a technique of (CSE) that depends on the theory of leakage of epidural drugs to the subarachnoid cerebrospinal fluid (CSF).

Patients and Methods:After approval of local medical ethics committee and obtaining informed consent, 60 patients (18-80 years, ASA physical status I to IV) who listed for orthopedic lower limb surgery under CSE were included in this study. The study design was prospective Cross-Section comparative one. It was done in Gulan General Hospital and Gian Private Hospital in Duhok Governorate in Kurdistan Region of Iraq in the period from 01/01/2017 to 28/2/2018.

Results:the volume needed to get maximum sensory block (MSB) and the frequency of top-up doses are greater in group A than B.The onset time of group A is longer than group B. The mean arterial pressure was much stable in group A with less nausea and vomiting in the same group. Addition, more patients in group A than group B were able to move against gravity.

Conclusions:the effect of this technique in combined spinal-epidural anesthesia can be compared to that of separate needle with more stable vital signs and less complications but with more allover doses of local anesthetics.


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