Combined spinal-epidural block in obstetrics.

Although epidural and spinal blocks are well-accepted regional techniques in obstetrics, they have several disadvantages. Combined spinal-epidural (CSE) technique reduces or eliminates the risks of these disadvantages. The sequential CSE technique can reduce the incidence and severity of maternal hypotension. CSE block combines the rapidity, density and reliability of spinal block with the flexibility of continuous epidural to extend the duration of analgesia. It has been used in thousands of patients without any reports of major problems. Catheter penetration through the dural hole though unlikely is not impossible. Before any injection in the epidural catheter, its position should always be confirmed by aspiration test. The technique should be used only by those who are experienced in spinal and epidural blocks. CSE is an important addition to the armamentarium of the obstetric anaesthesiologist.