Incidence of Paresthesia during Needle-through-Needle versus Double-Segment Techniques for Combined Spinal-Epidural Anesthesia / 대한마취과학회지

BACKGROUND: Paresthesia is unpleasant for patients and more importantly, is related to neurological injury in some cases. There have been few studies comparing combined spinal-epidural anesthesia (CSE) techniques such as needle-through-needle technique (NTN) and double segment technique (DST) regarding the incidence of paresthesia. METHODS: Eighty-four parturients undergoing CSE for an elective cesarean section were divided into NTN and DST groups. A CSE was performed using 27 G Sprotte needle, 18 G Tuohy needle and 20 G multiport catheter in both groups. In the NTN group, at L3-4 or L4-5, a spinal anesthesia was performed and then an epidural catheter was inserted through the same Tuohy needle. In the DST group, an epidural catheter was inserted at L1-2 or L2-3 and then a spinal anesthesia was done two interspaces caudally. Incidences of paresthesia with each procedure were recorded with block characteristics and adverse effects. RESULTS: Overall frequency of paresthesia was higher in the NTN group (54.8% vs. 29.3%, P = 0.033). Incidences of intrathecal paresthesia were three times higher (21.4% vs. 7.3%, not significant) and epidural paresthesia was significantly higher (45.2% vs. 22%, P = 0.044) in the NTN group. Sensory and motor block characteristics and side effects were mostly comparable between the groups. CONCLUSIONS: Double-segment technique shows less incidence of overall paresthesia compared to needle-through-needle.

Effect of Needle-through-Needle Method on Regional Anesthesia for Elective Caesarian Section / 대한마취과학회지

Spinal and epidural anesthesia were performed with a 26 gauge, long spinal needle through a 17 gauge Tuohy needle in thirty patients undergoing elective Caesarian section. To study the effects of subarachnoid local anesthetic solution, the thirty patients were classified into 3 groups on the anesthetics used respectively; a group treated with 0,5% hyperbaric tetracaine 10 mg alone (group I), a group treated 0.5% hyperbaric tetracaine 10 mg and fentanyl 10 mg (group II), a group treated 0.5% hyperbaric tetracaine 10 mg, fentanyl 10 ug and epinephrine 0.3 mg (group III). Each group contained 10 patients. The results were as follows. 1) Onset time of analgesia to T10 sensory level was significantly longer in group IlI than in remained groups and that to T4 sensory level was significantly shorter in group II than in other groups (p<0.05). 2) The time recovered from motor and sensory block was significantly longer in group III than in other groups (p<0.05). 3) The time requiring fentanyl from postoperative pain was significantly longer in group III than in other groups (p<0.05). 4) Complications after postoperative pain block were as follows; delayed awakening (3 cases), itching (3 cases), and one was nausea and vomiting. However serious complications such as respiratory depression did not occurred. In summary, We can concluded that use of needle-through-needle method of anesthesia for elective Caesarian section has benifits not only of spinal anesthesia but also of facilitating postoperative pain block.