Combined Spinal-Epidural Technique

The CSE technique, first reported as an option for cesarean section in 1984,^[185] has recently increased dramatically in popularity. The advantage of this technique is that it provides rapid onset of dense surgical anesthesia while allowing the ability to prolong the block with an epidural catheter. In addition, because the block can be supplemented at any time, the CSE technique allows the use of smaller doses of local spinal anesthetics, which may in turn reduce the incidence of high spinal block and hypotension.^[186] Potential problems of the CSE technique for cesarean delivery include an inability to test the catheter, the possibility of a failed epidural catheter after spinal injection, and the risk of enhanced spread of previously injected spinal drug after use of the epidural catheter.^[187] A detailed description of the CSE technique can be found in the section of this chapter on labor analgesia. Additionally, the reader is referred to a comprehensive review of the subject by Rawal and colleagues.^[188]