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Combined spinal epidural block versus spinal and epidural block for orthopaedic surgery

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In a controlled study a single segment combined spinal epidural (CSE) block was compared with spinal or epidural block for major orthopaedic surgery. Seventy-five patients, age 52–86 yr, were randomly assigned to receive one of the three blocks. Bupivacaine 0.5% was used for surgical analgesia. The postoperative pain relief after 4.0 mg epidural morphine was compared with the analgesic effect of 0.2 or 0.4 mg morphine administered intrathecally. With the spinal technique good or excellent surgical analgesia and muscle relaxation were achieved rapidly (11.8 ± 1.1 min). The time taken to provide an equally effective and reliable block with the CSE technique was no longer (14.9 ± 2.2 min). For epidural block with the catheter technique more time was required (35.9 ± 3.9 min) to provide acceptable surgical conditions (P < 0.05). Perioperative sedatives and concomitant analgesics were required more frequently and in larger doses by the patients undergoing surgery with epidural block (P < 0.05) than with CSE or spinal block. Our study demonstrated that the analgesia after surgery provided by 0.2 and 0.4 mg morphine administered intrathecally was comparable to that provided by 4.0 mg of epidural morphine. It is concluded that the analgesia and surgical conditions provided by the spinal and CSE blocks were similar and were superior to those provided by an epidural block.


Lors d’une étude contrôlée, on compare le bloc que produit l’association rachi-épidurale (CSE) à celui que produit chacune des deux techniques utilisées séparément en chirurgie orthopédique lourde. Soixante-quinze patients âgés de 52 à 86 ans sont assignés au hasard à recevoir un des trois blocs. La bupivacaïne 0,5% est employée pour l’analgésie chirurgicale. Le soulagement postopératoire avec morphine épidurale 4,0 mg est comparé avec celui que procure la morphine 0,2 ou 0,4 intrathécale. Avec la technique rachidienne, une analgésie de bonne à excellente et la relaxation musculaire surviennent rapidement (11,8 ±1,1 min). Le temps requis pour obtenir les mêmes résultats avec la technique CSE n’est pas plus long (14,9 ± 2,2 min). Pour le bloc épidural avec cathéter, plus de temps est requis (35,9 ± 3,9 min) pour l’atteinte de conditions chirurgicales acceptables (P < 0,05) qu’avec le CSE ou la rachi. Notre étude montre que l’analgésie postopératoire obtenue par la morphine 0,2 et 0,4 mg intrathécale est comparable à celle produite par la morphine 0,4 épidurale. On conclut que les condition produites par la rachi et la CSE sont indentiques entre elles et supérieures à celles du bloc épidural.


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Correspondence to Björn Holmström.

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Holmström, B., Laugaland, K., Rawal, N. et al. Combined spinal epidural block versus spinal and epidural block for orthopaedic surgery. Can J Anaesth 40, 601–606 (1993). https://doi.org/10.1007/BF03009695

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Key words

  • anaesthesia: orthopaedic
  • anaesthetic techniques: regional, epidural, spinal, combined spinal epidural (CSE)
  • analgesics: morphine
  • pain: postoperative