Continuous spinal anesthesia: what's new?

-Continuous spinal anaesthesia combines the advantages of single-dose spinal anaesthesia, rapid onset and a high degree of success, with those of a continuous technique.

-The introduction of micro-catheters invigorated interest in the technique and allowed its expansion to additional populations and surgical procedures. However, multiple cases of cauda equina syndrome associated with micro-catheters and (primarily) hyperbaric lidocaine solution led to withdrawal of micro-catheters from the US market.

-In 1992, FDA banned the use of spinal catheters thinner than 24G after 12 cases of cauda equina.

20G cathters are recommended in geriatric patients.

-Continuous spinal anesthesia provides adequate level and duration of anesthesia in elderly and high risk patients undergoing lower abdominal and lower limb surgery

-Indications: postoperative analgesia, chronic pain relief, previous spinal surgery, procedures of unpredictable length, significant cardiac disease, morbid obesity, difficult epidural catheter placement, difficult airway.

-Plain bupivacaine 0.5% is a safe local anesthetic during continuous spinal anesthesia.

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