Abstract
Even though continuous spinal anesthesia (CSA) received a bad reputation after reports of cauda equina syndrome associated with thin catheters and overdose of hyperbaric local anesthetics, it is still used and has a certain place in the anesthesiologists' armamentarium. CSA is used especially in elderly people for surgery of the lower extremities and abdomen. Bupivacaine is the most popular anesthetic. CSA with opioids is also used in obstetrics. If the catheter is inserted for surgery, it can be used also for postoperative pain relief. Best results have been obtained with a combination of opioids and bupivacaine either as a bolus dose or as a continuous infusion. Three different types of catheters are used: (1) Thin epidural catheters through Tuohy needles; (2) 28-gauge (G) catheter through 22-G Quincke or Sprotte needles; and (3) 22-G catheter over 27-G Quincke needle. Sufficient learning practice and certain manual dexterity is needed when using these devices. Problems have been encountered with kinking, dislodging of the connectors, and tearing. In spite of the problems, after proper learning continuous spinal anesthesia is a safe and reliable technique.
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