COMBINED SPINAL-EPIDURAL ANESTHESIA?
Legend to figures
1. Rib extraction - the first combined spinal-epidural
anesthesia? (Adam and Eve in the recovery room).
2. Needle-through-needle technique.
3. Eldor needle technique.
4. Huber needle technique.
5. Eldor, Coombs and Torrieri technique.
6. CSEA: "To paint the fence" from both its sides.
7. The volume effect of the extension of spinal anesthesia
by epidural injection of local anesthetic solution.
8. The flow of epidural local anesthetic into the spinal
space through the perforation produced by the spinal needle.
9. The "twin theory" of CSEA.
10. Metallic microparticles are produced by the friction
between the two needles in the needle-through-needle
technique.
11. Combined end-multiple lateral holes (CEMLH) epidural
catheter: 7 holes within the distal 15 mm.
12. Double-hole pencil-point (DHPP) spinal needle (Eldor
spinal needle): Tip`s view.
13. Inadvertent epidural catheter protrusion (B) through the
dural hole made by the spinal needle (A) in the
needle-through-needle technique.
14. Inadvertent epidural needle protrusion (A) and catheter
insertion (B) into the subarachnoid space in the
needle-through-needle technique.
15. A. The spinal conduit of the Eldor needle serves as a
break at the ligamentum flavum for an inadvertent insertion
into the spinal space.
B. The usual epidural needle has no such a break, so the
possibility of its inadvertent subarachnoid insertion is
higher.
16. A. Needle-through-needle technique: The Whitacre pencil
point spinal needle deflects by 10 degrees from the tip of the
epidural needle.
B. Eldor needle technique: The double-hole pencil point
spinal needle exits the spinal conduit of the Eldor needle
in a straight direction and parallel to the epidural tip.
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