Rawal N, Van Zundert A, Holmström B, Crowhurst J A
Department of Anesthesiology and Intensive Care, Orebro Medical Center Hospital, Sweden.
Reg Anesth. 1997 Sep-Oct;22(5):406-23. doi: 10.1016/s1098-7339(97)80026-0.
For the past 16 years the combined spinal-epidural (CSE) technique has been extensively researched and developed to the point where it is now in widespread use. Along with the use of low-dose mixtures of local anesthetics and opioids, and the introduction of fine-gauge pencil-point needles, CSE is being increasingly recognized as another important addition to the armamentarium of the anesthesiologist.
One hundred and forty-two publications focusing on the CSE technique, or on questions concerning CSE-related issues, were reviewed. Out of 33 double-blind or controlled studies, 23 directly investigated the CSE technique. Fifty-four prospective studies and letters made directly relevant points on advantages or problems with CSE. Twenty-one book chapters, reviews and editorials were included, 11 of them concerning the use of CSE technique.
All CSE techniques which may be used for surgical anesthesia, for analgesia in labor or for postoperative pain management are described. Indications, advantages, disadvantages, and the various methods for performing CSE procedures, including sequential CSE block, are described and reviewed, along with the equipment currently available for their administration.
The CSE technique offers many potential advantages over continuous epidural or subarachnoid methods alone, including a reduction in drug dosage, the ability to eliminate motor blockade and to achieve highly selective sensory blockade and optimize analgesia. These features hold great promise for minimizing the hazards and side effects of traditional epidural and subarachnoid techniques. Controversial fears, risks, and pitfalls of the CSE technique and of continuous epidural and subarachnoid methods are debated and discussed.
在过去16年中，联合脊髓硬膜外（CSE）技术得到了广泛的研究和发展，目前已被广泛应用。随着低剂量局部麻醉药和阿片类药物混合物的使用以及细针笔尖式穿刺针的引入，CSE越来越被认为是麻醉医生武器库中的又一重要补充。
回顾了142篇关注CSE技术或与CSE相关问题的出版物。在33项双盲或对照研究中，有23项直接研究了CSE技术。54项前瞻性研究和信函直接阐述了CSE的优点或问题。纳入了21章书籍、综述和社论，其中11篇涉及CSE技术的应用。
描述了可用于手术麻醉、分娩镇痛或术后疼痛管理的所有CSE技术。描述并综述了CSE操作的适应症、优点、缺点以及各种方法，包括序贯CSE阻滞，以及目前可用于其给药的设备。
与单纯连续硬膜外或蛛网膜下腔方法相比，CSE技术具有许多潜在优势，包括减少药物用量、消除运动阻滞的能力、实现高度选择性感觉阻滞以及优化镇痛效果。这些特性有望将传统硬膜外和蛛网膜下腔技术的风险和副作用降至最低。对CSE技术以及连续硬膜外和蛛网膜下腔方法存在争议的担忧、风险和陷阱进行了辩论和讨论。
