Comparison of double-segment technique with single-space technique for cesarean section using combined spinal epidural anesthesia

In patients scheduled for cesarean section (c-section) using combined spinal epidural anesthesia (CSEA), we compared the cephalad spreading speed during double-segment technique (DST) with that of single-space technique (SST) of CSEA. In the patients of SST group (n = 169), a 17-G Tuohy needle was introduced at the L 3-4, and then a long spinal needle was inserted through the Tuohy needle. In the patients of DST group (n = 16), a Tuohy needle was introduced at the T 11-12, and a spinal needle was inserted at the L 3-4. After 0.3% hyperbaric dibucaine 1.0 ml was injected through the spinal needle, 1.5% mepivacaine 10 ml was injected through the epidural catheter in both the groups. The analgesic level was measured at 5-min intervals, and blood pressure and complaints of patients were also recorded. The cephalad spread of analgesia was significantly higher in DST group than in SST group at 5 and 10 min after the administration of local anesthetics. Two patients in SST group, epidural catheterization was not possible. There were no difference in the incidences of hypotension, nausea and dyspnea between the groups. We conclude from these results that DST for CSEA is preferable to SST for c-section.