A Note in Continuous Spinal Anesthesia

James Moore^*
*Correspondence: James Moore, Department of Anesthesia and Pain Therapy, University Hospital, Parma, Italy, Email:

Brief Report

In modern anaesthetic practise, Continuous Spinal Anaesthesia (CSA) is a treatment that is underutilised. CSA allows for incremental dosing of an intrathecal local anaesthetic for an indefinite duration, whereas traditional single-shot spinal anaesthesia usually involves larger doses, a finite, unpredictable duration, and a higher risk of adverse hemodynamic effects such as hypotension, and epidural anaesthesia via a catheter may produce less motor block and suboptimal anaesthesia in sacral nerve root distributions. This paper compares CSA to other anaesthetic procedures, as well as describing its history, therapeutic applications, neurotoxicity issues, and other pharmacologic consequences. Since its first description in 1907, CSA's popularity in clinical practise has waxed and waned. Following case reports of cauda equina syndrome associated with the use of spinal microcatheters for CSA, these microcatheters were removed from clinical practise in the United States, although they were continued to be used in Europe with no more neurologic complications. Because only large-bore catheters are allowed in the US, CSA is mainly reserved for the elderly because to the danger of postdural puncture headache in younger patients. Even in younger individuals, the unique therapeutic benefits and hemodynamic stability associated with CSA might sometimes offset concerns about postdural puncture headache. Patients with severe aortic stenosis undergoing lower extremities surgery and obstetric patients with complex cardiac disease are two clinical settings in which CSA may be beneficial.

In modern anaesthetic practise, CSA is a technique that is underutilised. CSA, or fractional spinal anaesthesia, includes the delivery of a local anaesthetic solution via an intrathecal catheter on an intermittent basis. CSA allows titration of the block intensity to the patient's needs, provides a spinal block of unlimited length, and can give more hemodynamic stability than standard spinal anaesthesia, which entails a single injection with an unknown spread and duration of effect. Continuous spinal anaesthesia (CSA) has become more popular in recent years, prompting research initiatives aimed at decreasing the risks associated with the procedure. General CSA complications are the same as those associated with single-shot spinal anaesthesia, while specific CSA complications are those that are only related with CSA. Infection, backache, hematoma, and neurological sequelae are all common problems. Catheter use is linked to a variety of problems. The risk of developing the neurological complication of postdural puncture headache (PDPH) led to the use of microcatheters designed specifically for CSA. While the incidence of PDPH decreased with the use of microcatheters, the risk of developing the more serious complication of cauda equina syndrome increased, resulting in a Safety Alert being issued by the Food and Drug Administration [1-5].

The majority of anesthesiologists throughout the world use spinal anaesthesia as a regional approach. This method is taught early in the training process and is relatively simple to master. Despite being the oldest method of regional anaesthetic, it is still evolving and developing in numerous ways. This study aims to highlight the most recent advancements in this "near-perfect" approach in terms of indications, process, medicines, and strategies to reduce side effects. Postgraduates and practising anesthesiologists will benefit from a better understanding of the finer points and knowledge gaps when developing patient-specific procedures and interventions. Continuous spinal anaesthetic combines the benefits of single-dose spinal anaesthesia, such as quick onset and high success rates, with the benefits of a continuous approach. The introduction of micro-catheters reignited interest in the method, allowing it to grow to new heights. Multiple incidences of cauda equina syndrome linked to micro-catheters and (mainly) hyperbaric lidocaine solution led to the recall of micro-catheters in the United States, raising concerns about the safety of continuous spinal anaesthesia in general. It is feasible to reflect on the experience with continuous spinal anaesthesia for surgical anaesthetic and postoperative analgesia a decade after these occurrences and compare it to the available alternatives. Continuous spinal anaesthesia is still a valuable and safe method in this regard. Future studies should compare continuous spinal anaesthesia to the combined spinal/epidural approach, as well as the use of newer spinal drugs.

References

1. Sarkar, Arindam, and Rajeev Kumar, Das. "Assessment of efficacy of Continuous spinal anaesthesia."J Adv Med Dent Sci Res9 (2021): 91-94.

Google Scholar, Crossref, Indexed at

2. Teixeira, F, C Peixoto de Sousa, D Gonçalves and AP Pereira, et al. "70 Abdominal surgery in high-risk cardiovascular patient–anesthetic option." Reg Anesth Pain Med 3 (2021): 37-38.

Google Scholar, Crossref

3. Ferré, Fabrice, Charlotte Martin, Laetitia Boscha and Matt Kurrek, et al. "Control of spinal anesthesia-induced hypotension in adults."Local Reg Anesth13 (2020): 39.

Google Scholar, Crossref, Indexed at

4. Neuman, Mark, Rui Feng, Jeffrey Carson and Lakisha Gaskins, et al. "Spinal anesthesia or general anesthesia for hip surgery in older adults."New Eng J Med 385 (2021): 2025-2035.

Google Scholar, Crossref, Indexed at

5. Martin-Flores, Manuel. "Epidural and spinal anesthesia."Vet Clin Small Anim Pract49 (2019): 1095-1108.

Google Scholar, Crossref