Why bother with continuous spinal anaesthesia?

Abstract

Conventional spinal anaesthesia is simple, safe and well established. Why then should anyone choose to complicate the issue with a catheter? This is currently the view of most anaesthetists and it a view with much to comment it. However, single shot spinal anaesthesia (SSSA) does have limitations. A small percentage of SSSA blocks produce unilateral anaesthesia with an inadequate block. Alternatively, a block may wear off before surgery is complete. Although there is little published work on the safety of administering sedation or general anaesthesia immediately after spinal anaesthesia, anecdotal evidence points to significant problems, especially with hypotension. Lastly, there is the problem that the spinal anaesthesia provides exceptional analgesia for the surgery and recovery period, but does not provide analgesia postoperatively. There are also many patients for whom the risk of complications of SSSA, such as muscle paralysis, hypotension and the risk of a high block may lead to only general anaesthesia being considered. Continuous spinal anaesthesia (CSA) may therefore have a role in patients who are having surgery of the lower body, who have significant comorbidities and for whom SSSA is not absolutely contraindicated. There are too few publications to produce evidence-based guidelines on where CSA is best used, however, personal experience suggests