Continuous Spinal Anesthesia (CSA)

Regional anesthesia has several benefits over general anesthesia for orthopedic surgery [1]. Continuous spinal anesthesia (CSA) is the procedure of providing and maintaining spinal anesthesia by small doses of local anesthetic which are injected repeatedly as needed into the subarachnoid space through an indwelling catheter [2].Continuous spinal anesthesia (CSA) has been accepted as a reliable method for high-risk patients, it provides a higher control of local anesthetic spread over both loading and maintenance doses, with a more expected effect and lesser cardiovascular and pulmonary consequences [3].
Epidural anesthesia in opposition to spinal anesthesia is technically more complex, less reliable and needs a higher pharmacological dose of local anesthetics; causing systemic toxicity a matter. Also, epidural anesthesia provides some benefits; foremost among them is the low risk of post-dural puncture headache (PDPH), which makes it a proper option for both young and old patients [4]
CSA possesses numerous advantages over a single-shot spinal anesthesia: (1) giving local anesthetics in small incremental doses according to the patient’s needs; (2) decreased doses of local anesthetics and thus decreased systemic toxic effects; (3) assured hemodynamic stability; and (4) prolonged anesthesia by supplemental doses of spinal local analgesics when surgery is lengthened [5].
A unique catheter-over-needle design has been produced to reduce the difficulties and complications of continuous spinal anesthesia with microcatheters [6], which involve difficult catheter insertion, breakage, poor anesthesia, (PDPH), and, infrequently, development of cauda equina syndrome
[7].
CSA has been used in medically complex patients undergoing vascular, orthopedic, and general surgeries. Many authors support general anesthesia with Epidural analgesia as the first option in healthy patients undergoing abdominal surgeries. Though in high-risk patients undergoing surgeries on the lower limbs, groin, and lower abdomen, in whom general anesthesia is expected to increase morbidity and mortality, many authors support CSA as an option to general anesthesia [8].
This study was carried on high-risk aged patients undergoing orthopedic lower extremity surgeries to detect the safety and effectiveness of continuous spinal anesthesia (CSA) using Spinocath and continuous epidural anesthesia (CEA (. The primary outcome of this study is the mean arterial blood pressure and the onset time between both techniques. Secondary outcomes include characteristics of sensory block, motor block as well as early and late neurological complications.