Combined Spinal Epidural Causes a Higher Level of Block than Equivalent, Single-Shot Spinal Anesthesia in Elective Cesarean Patients

Abstract

To the Editor: Ithnin et al. (1) report that entering the epidural space with the epidural needle, without giving any medicine, affects the level of spinal anesthesia. They posit that negative pressure in the epidural space entrains air increasing the pressure in the epidural space. This narrows the intrathecal space, leading to a higher block from intrathecal local anesthetics. Couldn’t the same phenomenon occur if the stylet is removed from a spinal needle and the tip of the needle is in the epidural space? If so, then this should also result in a higher block. Geeta Tayal, MD Rajinder K. Mittal, MCh Department of Plastic Surgery Sunil Katyal, MD Department of Anesthesiology Dayanand Medical College Hospital Ludhiana, India [email protected]