[Survey of combined spinal-epidural anesthesia in Japan--analysis of questionnaire from 148 hospitals].

Combined spinal-epidural anesthesia (CSEA) offers theoretic advantages especially for lower abdominal and limb surgery, because it produces the rapid onset of anesthesia and the proper muscle relaxation, with the option to extend the blockade with an epidural catheter. Whereas it is not known whether this anesthetic method is commonly used in clinical practice in Japan. We analyzed questionnaires on CSEA obtained form 148 hospitals. It was revealed that most anesthesiologists in Japan preferred general anesthesia with epidural block for lower abdominal surgery to CSEA. For lower limb surgery longer than 2 hrs, CSEA was employed in 57 hospitals (39%). CSEA was mainly used for orthopedics, obstetrics and gynecology and urology. Double needle double interspace method was commonly used rather than needle through needle method. In general, CSEA was not a widely performed anesthetic technic in Japan. CSEA should contribute to reduction of the incidence of postoperative nausea and vomiting caused by general anesthetics, and produce pre-emptive analgesia. We hope CSEA to be a common anesthetic procedure, although some disadvantages exist in training system for junior staff, national health insurance scheme and available local anesthetics in Japan.