Comparison of neuraxial anesthesia techniques

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

PDPH: post-dural-puncture headache.
* Speed of onset of anesthesia depends on the drug, speed of medication administration, concentration, and volume of the epidural solution. Slower onset may be a disadvantage in some clinical situations (eg, emergency cesarean delivery), but may be an advantage for patients who would benefit from slow onset of sympathectomy (eg, patients with preload dependent cardiac lesions).
¶ Sequential combined spinal-epidural (CSE) technique verifies epidural catheter function soon after placement.

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Comparison of neuraxial anesthesia techniques