Combined spinal-epidural (CSE) anaesthesia is used for labour analgesia. The Tuohy needle is inserted at L2–L3, a 27G pencil-point spinal needle passed through it 1.5 cm beyond the tip into the subarachnoid space, and fentanyl 25 mcg with bupivacaine 2.5 mg injected intrathecally. Which advantage is unique to CSE over either technique alone?

• A More predictable level of block than spinal alone
• B Eliminates PDPH risk
• C Allows drug titration without neuraxial access
• D Immediate dense sacral block combined with epidural catheter for extension, top-up, or post-operative analgesia ✓

Explanation

CSE combines the rapid, dense, predictable onset of spinal anaesthesia (for immediate pain relief) with the flexibility of the epidural catheter (for prolonging block, adjusting dermatomal spread, top-up analgesia for operative delivery, and post-operative analgesia). The spinal component provides quick sacral coverage important for labour pain; the epidural catheter allows titration if the operation is prolonged beyond spinal duration. Limitations include: inability to immediately test epidural catheter (not injected at time of spinal), slightly higher risk of catheter misplacement, and theoretical risk of meningitis (needle-through-needle contact).

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.