59 Continuous spinal anesthesia – a newborn technique for times of need?

Abstract

Background and AimsDescribed during World War II, continuous spinal anesthesia (CSA) enables continuous administration of intrathecal drugs, offering several anesthetic options versus single shot technique, although underutilised.Here we present 4 cases of CSA performed for patients undergoing urgent upper abdominal and lower extremity orthopedic surgery during the COVID-19 pandemic. Our patients were ranked between 90–100 years old with ASA score IV, in which we highlight the presence of ischemic heart disease and chronic obstructive pulmonary disease.MethodsInvasive hemodynamic measurement was performed before CSA technique. Given the lack of microcatheter-over-the-needle kits in our center, we performed the technique using Perifix® Complete Set – B Braun, with full aseptic technique. The 18G Tuohy needle was introduced via a midline approach until CSF was encountered. The 20G catheter was then introduced 3cm into the subarachnoid space. In all situations we opted for the administration of sufentanil 0.0025 mg plus subsequent aliquots of hyperbaric bupivacaine 0.125%, guided by sensory assessment of block level.ResultsAll surgeries were successfully concluded with minimal haemodynamic variation and avoidance of mechanical invasive ventilation. Patients were admitted in the PACU, where spinal catheters were removed, and continued their recovery at the speciality yard. No complications were observed, particularly post-dural puncture headache, neurologic or infectious events.ConclusionsCSA is a useful anesthetic technique with a low failure rate. Its best role is likely to be in high-risk surgical patients, as it can provide excellent blockade conditions, with small doses of LA and little haemodynamic variation frequently seen with single shot techniques.