Technique | Advantages | Disadvantages |
Single shot spinal | - Rapid onset of block
- Reliably symmetric block, including sacral nerve roots
- Low doses of local anesthetic and opioids
- Technically easy
| - Limited duration of action
- Limited ability to extend block
- Requires dural puncture
|
Epidural | - Can prolong the duration and extend block
- Relatively slow onset of anesthesia*
- May be used to provide postoperative analgesia
| - Relatively slow onset of anesthesia*
- Higher doses of local anesthetics and opioids than spinal
- High risk of PDPH with unintentional dural puncture
- Possibility of patchy or asymmetric block
- Unreliable sacral block
|
Combined spinal-epidural | - Rapid onset of block
- Reliably symmetric block, including sacral nerve roots
- Can prolong the duration and extend block
- Option to titrate level of block
- Low doses of local anesthetic and opioids (spinal component)
- May be used to provide postoperative analgesia
| - May take longer than single shot spinal
- Delayed confirmation of functional epidural catheter¶
|
Continuous spinal | - Rapid onset of block
- Reliably symmetric block, including sacral nerve roots
- Can prolong the duration and extend block
- Low doses of local anesthetic and opioids
- Option to titrate onset of block
| - High incidence of PDPH with large dural puncture
- Possible higher risk of medication errors leading to a high spinal
|