Möllmann M
Abteilung für Anästhesiologie und operative Intensivmedizin, St Franziskus-Hospital Münster.
Anaesthesist. 1997 Jul;46(7):616-21. doi: 10.1007/s001010050446.
Continuous spinal anaesthesia (CSA) is a further means of central nerve block for anaesthesia besides single-shot spinal (SSS), combined spinal/epidural, and epidural anaesthesia. Major advantages compared to SSS are the possibility of subsequent injection of local anaesthetic via the indwelling catheter, which enables analgesia to be maintained over a longer period. Moreover, the haemodynamic effects are diminished by this mode of application. The most important advantages of CSA compared to continuous epidural anaesthesia are the more rapid onset of action, better quality of analgesia, and better muscle relaxation. Since small doses of local anaesthetic are used in CSA, there is less danger of systemic toxic reactions. The microcatheters used up to now for CSA are introduced via relatively large needles that cause perforation trauma to the dura, resulting in loss of cerebrospinal fluid (CSF) and thus a higher incidence of post-dural punctive headache. Hence, further technical developments must have the objectives of reducing needle diameter and increasing catheter diameter. Perforation trauma to the dura is reduced by using small needles. Use of a larger catheter enables better mixing of the local anaesthetic with the CSF, and it is easier to aspirate CSF in order to establish the correct position of the catheter.
连续蛛网膜下腔麻醉（CSA）是除单次蛛网膜下腔阻滞（SSS）、腰麻-硬膜外联合麻醉和硬膜外麻醉之外的另一种用于麻醉的中枢神经阻滞方法。与单次蛛网膜下腔阻滞相比，其主要优点是可以通过留置导管后续注射局部麻醉药，从而能够维持更长时间的镇痛。此外，这种给药方式可减轻血流动力学效应。与连续硬膜外麻醉相比，连续蛛网膜下腔麻醉最重要的优点是起效更快、镇痛质量更好以及肌肉松弛效果更佳。由于连续蛛网膜下腔麻醉使用的局部麻醉药剂量较小，发生全身毒性反应的风险较低。目前用于连续蛛网膜下腔麻醉的微导管是通过相对较粗的穿刺针置入的，这会对硬脊膜造成穿孔损伤，导致脑脊液（CSF）流失，进而使腰麻后头痛的发生率更高。因此，进一步的技术改进必须以减小穿刺针直径和增大导管直径为目标。使用细针可减少对硬脊膜的穿孔损伤。使用较粗的导管能使局部麻醉药与脑脊液更好地混合，并且更容易抽出脑脊液以确定导管的正确位置。
