Optimizing Anesthesia for Major Surgery: The Role of Sequential Combined Spinal-Epidural Technique

Notice

This is an unedited manuscript accepted for publication and provided as an Article in Press for early access at the author’s request. The article will undergo copyediting, typesetting, and galley proof review before final publication. Please be aware that errors may be identified during production that could affect the content. All legal disclaimers of the journal apply.

Year : 2025 | Volume : 14 | Issue : 02 | Page : 12-18
    By

    Sheezan Shafi,

  • Kaisar ahmad Bhat,

  1. Assistant Professor, Department of Allied Sciences, Bee Enn College of Nursing, Chak Bhalwal, Jammu and Kashmir, India
  2. Assistant professor, Bee Enn college of nursing chak balwal, Jammu & Kashmir, India

Abstract

document.addEventListener(‘DOMContentLoaded’,function(){frmFrontForm.scrollToID(‘frm_container_abs_190304’);});Edit Abstract & Keyword

The Combined Spinal Epidural (CSE) approach has been widely employed over the last decade because it achieves rapid onset and substantial blockage while also allowing for the modification or prolongation of the block. Background: Sequential spinal-epidural anesthesia (SSEA) combines the rapid onset and dense blockade of spinal anesthesia with the prolonged duration and adjustable analgesia of epidural anesthesia. This technique is particularly beneficial in major surgeries requiring prolonged operative time and stable hemodynamics. Objective: To evaluate the efficacy and safety of SSEA in major surgical procedures compared to single-shot spinal or epidural anesthesia alone. Methods: A systematic review of clinical studies and case reports analyzing patient outcomes, hemodynamic stability, anesthetic efficacy, and postoperative analgesia with SSEA in major surgeries, including orthopedic, abdominal, and vascular procedures. Results: SSEA provides superior intraoperative hemodynamic stability, extended postoperative analgesia, and reduced anesthetic and opioid requirements. The combination allows for precise control of anesthesia depth, minimizing complications, such as hypotension and excessive motor blockade. Conclusion: For major surgery, SSEA is a safe and efficient method that improves patient outcomes and perioperative management. To improve techniques and increase their use, more extensive research is required.

Keywords: Sequential Spinal Epidural Anesthesia, Combined Spinal-Epidural Anesthesia, Major Surgery, Hemodynamic Stability, Postoperative Analgesia, Orthopedic Surgery

[This article belongs to Research and Reviews : Journal of Surgery ]

How to cite this article:
Sheezan Shafi, Kaisar ahmad Bhat. Optimizing Anesthesia for Major Surgery: The Role of Sequential Combined Spinal-Epidural Technique. Research and Reviews : Journal of Surgery. 2025; 14(02):12-18.
How to cite this URL:
Sheezan Shafi, Kaisar ahmad Bhat. Optimizing Anesthesia for Major Surgery: The Role of Sequential Combined Spinal-Epidural Technique. Research and Reviews : Journal of Surgery. 2025; 14(02):12-18. Available from: https://journals.stmjournals.com/rrjos/article=2025/view=0


document.addEventListener(‘DOMContentLoaded’,function(){frmFrontForm.scrollToID(‘frm_container_ref_190304’);});Edit

References

  1. Datta S, Alper MH, Ostheimer GW, Weiss JB. Method of ephedrine administration and nausea and hypotension during spinal anesthesia for cesarean section. Anesthesiology. 1982;56(1):68–70.
  2. Thorburn J, Moir DD. Bupivacaine toxicity in association with extradural analgesia for caesarean section. Br J Anaesth. 1984;56(6):551–3.
  3. Soresi A. Episubdural anesthesia. Anesth Analg. 1937;16(6):306–10.
  4. Holmström B, Laugaland K, Rawal N, Hallberg S. Combined spinal block versus spinal and epidural block for orthopedic surgery. Can J Anaesth. 1993;40(7):601–6.
  5. Gupta S, Sharma R, Gupta R. Comparative evaluation of combined spinal epidural anesthesia versus epidural anesthesia in lower limb surgeries. J Anaesthesiol Clin Pharmacol. 2014;30(1):78–83.
  6. Catarci S, Sbaraglia F, Zanfini BA, Vagnoni S, Frassanito L, Draisci G. Combined spinal-epidural anesthesia in an urgent cesarean section for a patient with a single ventricle and phasic pulmonary artery flow: a case report. J Clin Anesth. 2018;49:39–41.
  7. Agarwal A, Garg R, Joshi A, Verma S. Combined spinal-epidural anesthesia with epidural volume extension for hysterectomy in a patient with ventricular septal defect and pulmonary atresia: A case report. Saudi J Anaesth. 2016;10(1):99–101.
  8. Rawal N, Holmström B, Crowhurst JA, Van Zundert A. The combined spinal-epidural technique. Anesthesiol Clin North Am. 2000;18(2):267–95.
  9. Choi DH, Ahn HJ, Kim MH. The effect of intravenous dexmedetomidine on spinal anesthesia with hyperbaric bupivacaine. Anesth Analg. 2014;119(6):1359–64.
  10. Rawal N, van Zundert A, Holmström B, Crowhurst JA. Combined spinal epidural technique. Reg Anesth. 1997;22(5):406–23.
  11. Collis RE, Davis DW, Aveling W. Randomized comparison of combined spinal epidural and standard epidural analgesia in labor. Lancet. 1995;345(8960):1413–6.
  12. Rawal N, Schollin J, Wesström G. Epidural versus spinal epidural block for Caesarean section. Acta Anaesthesiol Scand. 1988;32(1):61–6.
  13. Thoren T, Holmström B, Rawal N, Hallberg S. Sequential combined spinal epidural block versus spinal block for cesarean section: Effects on maternal hypotension and neurobehavioral function of the newborn. Anesth Analg. 1994;78(6):1087–92.
  14. McMorland GH, Douglas MJ. Effect of pH adjustments of bupivacaine on onset and duration of epidural analgesia for caesarean section. Can J Anaesth. 1988;35(5):457–60.
  15. Alahuhta S, Kangas-Saarela T, Hollmén AI, and Edström HH was published in the journal Acta Anaesthesiologica Scandinavica in 1990. It appears in Volume 34, Issue 2, on pages 95–98.
Regular Issue Subscription Original Research
Volume 14
Issue 02
Received 21/02/2025
Accepted 29/03/2025
Published 24/05/2025
Publication Time 92 Days
110

[first_name] [last_name]

My IP

PlumX Metrics