Needle through Needle Combined Spinal Epidural Anaesthesia - A Case Report

Background: The combined spinal?epidural technique (CSE) has become increasingly popular in recent years. It can be defined as the intentional injection of drug into the subarachnoid space and the placement of a catheter into the epidural space as part of the same procedure. Both midline and paramedian approaches can be used for CSE . In the Needle-through-needle technique epidural needle is used to identify the epidural space. A spinal needle is then passed through the epidural needle into the subarachnoid space and the subarachnoid block performed. After the removal of the spinal needle, an epidural catheter is placed that can be used subsequently. Developments of this technique have included the design of epidural needles with ?backeyes? or holes in the greater curvature of the needles, which allow the epidural catheter to be inserted away from the dural puncture site, thus reducing the risk of inadvertent subarachnoid placement of the epidural catheter. Success rates of up to 99% have been reported with certain ?locking? needles, which is comparable with the reported success rates of 98% with conventional ?non-locking? needles used in some studies. We report a case of 76 year old patient with long standing history of diabetes and hypertension with anticipated difficult spine who sustained an inter trochanteric fracture left femur for Proximal femur nailing(PFN) an aesthetically managed by Needle through needle technique of combined spinal epidural anaesthesia.