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Epidural and combined spinal-epidural anesthesia: Techniques

Unyime Ituk, MBBS, FCARCSI
Cynthia A Wong, MD
Section Editor
Robert Maniker, MD
Deputy Editor
Marianna Crowley, MD


Epidural anesthesia is a type of neuraxial anesthesia; local anesthetic (LA) is injected into the epidural space to anesthetize the spinal nerve roots that traverse the space. Epidural anesthesia is used for anesthesia of abdominal, pelvic, and lower extremity procedures and, less commonly, thoracic procedures. It may be used to supplement general anesthesia for thoracic, abdominal, and pelvic procedures and for postoperative analgesia following these procedures. The usual technique involves siting a catheter in the epidural space. LA solution and adjuvants are administered through the catheter, both to initiate and maintain anesthesia for the duration of the surgical procedure.

This topic will discuss the relevant anatomy, techniques, and management of epidural and combined spinal-epidural anesthesia. The technique for spinal anesthesia is discussed separately. (See "Spinal anesthesia: Technique" and "Overview of neuraxial anesthesia".)


Spinal, epidural, and combined spinal-epidural (CSE) anesthesia can be used for many of the same surgical procedures. Differences among them may affect the choice of technique for a specific procedure or patient. The advantages and disadvantages of the various neuraxial anesthesia techniques are shown in a table (table 1). Spinal anesthesia is usually administered as a single shot, whereas epidural anesthesia is usually administered via a catheter (thus it is a continuous technique), and CSE anesthesia combines the two.

Catheter-based neuraxial anesthesia (ie, epidural, CSE, and continuous spinal) allows prolonged anesthesia and titration of the onset of the anesthetic. Single-shot spinal or epidural anesthesia is limited to the duration of action of the injected drug.


Epidural anesthesia is performed by introducing a needle between the lumbar, thoracic, or cervical vertebrae and injecting anesthetic medication into the epidural space, via the epidural needle and/or a catheter inserted through the needle into the epidural space (figure 1). Detailed anatomy of the bony spine and vertebrae are discussed separately (figure 2 and figure 3) (see "Spinal column injuries in adults: Definitions, mechanisms, and radiographs", section on 'Anatomy'). This topic will focus on lumbar and thoracic epidural anesthesia/analgesia. Cervical epidural injections are done mostly for pain procedures and are outside the scope of this topic.

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Literature review current through: Sep 2017. | This topic last updated: Jul 25, 2017.
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