{
 "id": "ep2s2z2fhf",
 "slug": "neuraxial-anesthesia",
 "title": "Neuraxial anesthesia",
 "updated": "2026-10-15",
 "topic_path": [
  {
   "id": "life",
   "label": "Life and health",
   "api_url": "https://www.edgepedia.org/api/v1/topics/life"
  },
  {
   "id": "life.health",
   "label": "Human health and medicine",
   "api_url": "https://www.edgepedia.org/api/v1/topics/life.health"
  },
  {
   "id": "life.health.clinical",
   "label": "Clinical assessment and procedures",
   "api_url": "https://www.edgepedia.org/api/v1/topics/life.health.clinical"
  },
  {
   "id": "life.health.clinical.clinical-anesthesia",
   "label": "Anesthesiology and perioperative care",
   "api_url": "https://www.edgepedia.org/api/v1/topics/life.health.clinical.clinical-anesthesia"
  },
  {
   "id": "life.health.clinical.clinical-anesthesia.neuraxial-anesthesia-and-analgesia",
   "label": "Neuraxial anesthesia and analgesia",
   "api_url": "https://www.edgepedia.org/api/v1/topics/life.health.clinical.clinical-anesthesia.neuraxial-anesthesia-and-analgesia"
  }
 ],
 "geo": [
  {
   "id": "geo.nongeo.t1800.life.health.clinical.clinical-anesthesia",
   "label": "Non-geographic · 1800 to 1945: Anesthesiology and perioperative care",
   "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1800.life.health.clinical.clinical-anesthesia",
   "path": [
    {
     "id": "geo.nongeo",
     "label": "Non-geographic",
     "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo"
    },
    {
     "id": "geo.nongeo.t1800",
     "label": "Non-geographic · 1800 to 1945",
     "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1800"
    },
    {
     "id": "geo.nongeo.t1800.life",
     "label": "Life and health",
     "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1800.life"
    },
    {
     "id": "geo.nongeo.t1800.life.health",
     "label": "Human health and medicine",
     "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1800.life.health"
    },
    {
     "id": "geo.nongeo.t1800.life.health.clinical",
     "label": "Clinical assessment and procedures",
     "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1800.life.health.clinical"
    },
    {
     "id": "geo.nongeo.t1800.life.health.clinical.clinical-anesthesia",
     "label": "Anesthesiology and perioperative care",
     "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1800.life.health.clinical.clinical-anesthesia"
    }
   ]
  },
  {
   "id": "geo.nongeo.t1946.life.health.clinical.clinical-anesthesia",
   "label": "Non-geographic · 1946 to 2000: Anesthesiology and perioperative care",
   "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1946.life.health.clinical.clinical-anesthesia",
   "path": [
    {
     "id": "geo.nongeo",
     "label": "Non-geographic",
     "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo"
    },
    {
     "id": "geo.nongeo.t1946",
     "label": "Non-geographic · 1946 to 2000",
     "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1946"
    },
    {
     "id": "geo.nongeo.t1946.life",
     "label": "Life and health",
     "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1946.life"
    },
    {
     "id": "geo.nongeo.t1946.life.health",
     "label": "Human health and medicine",
     "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1946.life.health"
    },
    {
     "id": "geo.nongeo.t1946.life.health.clinical",
     "label": "Clinical assessment and procedures",
     "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1946.life.health.clinical"
    },
    {
     "id": "geo.nongeo.t1946.life.health.clinical.clinical-anesthesia",
     "label": "Anesthesiology and perioperative care",
     "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1946.life.health.clinical.clinical-anesthesia"
    }
   ]
  }
 ],
 "excerpt": "Neuraxial anesthesia is regional anesthesia injected near the spinal cord, comprising single-injection spinal anesthesia and catheter-based epidural anesthesia, used for labor analgesia and as the standard anesthetic for cesarean delivery.",
 "snippet": "Neuraxial anesthesia is regional anesthesia injected near the spinal cord, comprising single-injection spinal anesthesia and catheter-based epidural anesthesia, used for labor analgesia and as the standard anesthetic for cesarean delivery.",
 "node": "life.health.clinical.clinical-anesthesia.neuraxial-anesthesia-and-analgesia",
 "markdown": "# Neuraxial anesthesia\n\nNeuraxial anesthesia comprises spinal anesthesia, usually a single injection into the cerebrospinal fluid, and epidural anesthesia, usually a catheter placed in the epidural space for continuous infusion; combined spinal-epidural (CSE) uses both.<sup>[1](https://www.uptodate.com/contents/overview-of-neuraxial-anesthesia)</sup> Neuraxial anesthesia is the recommended default anesthetic for cesarean delivery <sup>[2](https://www.ajog.org/article/S0002-9378%2825%2900334-5/fulltext)</sup> and is also used for labor analgesia and for surgery below the umbilicus.\n\n| Key fact | Detail |\n|---|---|\n| Techniques for cesarean delivery | Single-shot spinal, epidural, CSE, dural puncture epidural (DPE), and continuous spinal via intrathecal catheter <sup>[2](https://www.ajog.org/article/S0002-9378%2825%2900334-5/fulltext)</sup> |\n| Injection site | Spinal at L3/4 or L4/5 (adult conus medullaris on average at the lower third of L1) <sup>[3](https://www.ncbi.nlm.nih.gov/books/NBK537299/)</sup>; epidural anywhere from the sacral hiatus to a high cervical interspace <sup>[1](https://www.uptodate.com/contents/overview-of-neuraxial-anesthesia)</sup> |\n| Spinal drug durations | Lidocaine 5%: onset 3–5 min, duration 60–90 min; bupivacaine 0.75%: onset 5–8 min, duration 90–150 min <sup>[3](https://www.ncbi.nlm.nih.gov/books/NBK537299/)</sup> |\n| Labor analgesia onset | Epidural 15–20 min; CSE 2–5 min, with lower catheter replacement rates (1.49% vs 3.18%) <sup>[4](https://anesth-pain-med.org/journal/view.php?number=1370)</sup> |\n| Hypotension | Up to 47% of spinal anesthetics overall <sup>[1](https://www.uptodate.com/contents/overview-of-neuraxial-anesthesia)</sup>; 80–90% in elective cesarean parturients versus 25–75% in the general population <sup>[5](https://www.dovepress.com/effects-of-hyperbaric-and-isobaric-bupivacaine-on-hemodynamic-profiles-peer-reviewed-fulltext-article-JPR)</sup> |\n| Vertebral canal hematoma | 0.85 per 100,000 neuraxial blocks in the UK NAP3 audit <sup>[6](https://esraeurope.org/wp-content/uploads/2021/01/UK_Regional_anaesthesia_abnormalities_coagulation.pdf)</sup>; traditional estimates below 1 in 150,000 epidural and 1 in 220,000 spinal <sup>[7](https://www.swa10.com/uploads/6/1/4/3/61438899/anticoag___regional.asra.2024.pdf)</sup> |\n| Common adjuvants | Fentanyl reduces bupivacaine's minimum local analgesic concentration by 31–72% <sup>[4](https://anesth-pain-med.org/journal/view.php?number=1370)</sup>; morphine extends post-cesarean analgesia 12–24 h <sup>[2](https://www.ajog.org/article/S0002-9378%2825%2900334-5/fulltext)</sup> |\n\n## How it works\n\nA spinal injection places drug directly into the cerebrospinal fluid (CSF) bathing the nerve roots.<sup>[1](https://www.uptodate.com/contents/overview-of-neuraxial-anesthesia)</sup> An adult holds roughly 130–140 mL of CSF and produces about 500 mL daily <sup>[3](https://www.ncbi.nlm.nih.gov/books/NBK537299/)</sup>, so intrathecal drug distributes widely and acts on roots leaving the cord. Sympathetic block precedes sensory block, which precedes motor block; among sensory modalities the order of loss is temperature, pain, touch, pressure, and finally proprioception.<sup>[8](https://aneskey.com/neuraxial-blocks-spinal-and-epidural-anesthesia/)</sup>\n\n**Baricity controls spread.** Solution density relative to CSF determines where intrathecal drug travels. Glucose-free 0.5% bupivacaine has baricity 0.9990 at 37 °C and glucose-free ropivacaine 0.9988, so both behave as slightly hypobaric at body temperature <sup>[9](https://journals.lww.com/anesthesia-analgesia/fulltext/2001/07000/hyperbaric_spinal_ropivacaine_for_cesarean.31.aspx)</sup>, whereas 0.5% bupivacaine in 8% glucose stays hyperbaric with more predictable spread.<sup>[10](https://www.nature.com/articles/s41598-021-88726-2)</sup> Block height drives the main physiologic effect: sympathectomy-induced hypotension becomes clinically significant when the block reaches the T4–T6 level.<sup>[11](https://link.springer.com/chapter/10.1007/978-3-032-16811-5_15)</sup>\n\n## How it is done\n\n**Spinal block.** The block is placed at the L3/4 or L4/5 interspace.<sup>[3](https://www.ncbi.nlm.nih.gov/books/NBK537299/)</sup> In the midline approach the needle passes through skin, subcutaneous fat, the supraspinous and interspinous ligaments, the ligamentum flavum, and the epidural space until dural penetration is signaled by free-flowing CSF.<sup>[3](https://www.ncbi.nlm.nih.gov/books/NBK537299/)</sup>\n\n**Epidural placement.** The needle is advanced toward the epidural space, entered on average about 4 cm from the skin, and identified by loss of resistance: gentle injection of air or saline suddenly meets no resistance when the tip enters the space.<sup>[12](https://www.ncbi.nlm.nih.gov/books/NBK542219/)</sup> A catheter is advanced to the 20 cm mark and withdrawn to leave 5–6 cm of tip in the space, then tested with 3 mL of lidocaine 1.5% with 1:200,000 epinephrine; a heart-rate rise of 20–30 bpm or 15–20 mm Hg systolic suggests intravascular placement.<sup>[12](https://www.ncbi.nlm.nih.gov/books/NBK542219/)</sup> Above the T11 vertebra a paramedian approach is generally used because of thoracic spinous angulation.<sup>[12](https://www.ncbi.nlm.nih.gov/books/NBK542219/)</sup>\n\n**Dosing.** Dose matters sharply: in repeat spinal anesthesia, 12 mg of hyperbaric bupivacaine caused hypotension in 85% versus 31.6% with 10 mg.<sup>[13](https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.937963/full)</sup> Epidural mixtures commonly add fentanyl, which cuts bupivacaine requirements by 31–72% depending on dose <sup>[4](https://anesth-pain-med.org/journal/view.php?number=1370)</sup>, and intrathecal morphine for 12–24 hours of postoperative analgesia.<sup>[2](https://www.ajog.org/article/S0002-9378%2825%2900334-5/fulltext)</sup>\n\n## Origin\n\n[August Bier](https://www.edgepedia.org/august-bier)'s paper *Versuche über Cocainisirung des Rückenmarkes* (Deutsche Zeitschrift für Chirurgie, 1899) reported the first spinal anesthetic and the first operation under spinal anesthesia.<sup>[14](https://doi.org/10.1007/bf02792160)</sup> Dudley Tait's *Experimental and clinical notes on the subarachnoid space* (JAMA, 1900) describes the first spinal anesthetic in America.<sup>[15](https://doi.org/10.1001/jama.1900.24620270006001a)</sup> Manuel Martinez Curbelo's *Continuous peridural segmental anesthesia by means of a ureteral catheter* ([Anesthesia](https://www.edgepedia.org/anesthesia) & [Analgesia](https://www.edgepedia.org/analgesia), 1949) described continuous peridural segmental anesthesia using a ureteral catheter passed through a 16G Tuohy needle.<sup>[16](https://doi.org/10.1213/00000539-194901000-00002)</sup>\n\n## Variants\n\n**Combined spinal-epidural** pairs a spinal injection with an epidural catheter, combining spinal anesthesia's rapid onset, profound block, and low drug dose with the epidural's titratable level and indefinite prolongation.<sup>[17](https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1046/j.1365-2044.2000.01157.x)</sup> The needle-through-needle method, passing a 25 or 27G spinal needle through the epidural needle, is used by 73% of surveyed UK consultants.<sup>[18](https://www.sciencedirect.com/science/article/abs/pii/S1521689623000228)</sup> In obstetrics, CSE reduces local anesthetic consumption by 25% with less motor block and a more reliable catheter than conventional epidural.<sup>[18](https://www.sciencedirect.com/science/article/abs/pii/S1521689623000228)</sup>\n\n**Other variants.** Dural puncture epidural is a CSE without intrathecal drugs; continuous spinal uses an intrathecal catheter.<sup>[2](https://www.ajog.org/article/S0002-9378%2825%2900334-5/fulltext)</sup> The [caudal block](https://www.edgepedia.org/caudal-anesthesia) injects into the caudal epidural space at the sacral hiatus, often in pediatric patients and for perineal procedures in adults.<sup>[12](https://www.ncbi.nlm.nih.gov/books/NBK542219/)</sup> Ultrasound-guided neuraxial procedures show lower technical failure (RR 0.5) and fewer traumatic insertions (RR 0.3) than landmark techniques, whose surface landmarks are inaccurate in 30–60% of pregnant women <sup>[4](https://anesth-pain-med.org/journal/view.php?number=1370)</sup>; ultrasound also helps when scarring or spine hardware obliterates landmarks.<sup>[1](https://www.uptodate.com/contents/overview-of-neuraxial-anesthesia)</sup>\n\n## Applications\n\nNeuraxial anesthesia is the gold standard for cesarean delivery, endorsed by obstetric and anesthesiology societies <sup>[2](https://www.ajog.org/article/S0002-9378%2825%2900334-5/fulltext)</sup>, though intraoperative pain still occurs in about 15% of cesareans and shivering in up to 50%.<sup>[2](https://www.ajog.org/article/S0002-9378%2825%2900334-5/fulltext)</sup> Epidural or spinal anesthesia for cesarean is inadequate in up to 4% of cases, and CSE has been suggested to cut conversion to general anesthesia to 0.16%.<sup>[17](https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1046/j.1365-2044.2000.01157.x)</sup>\n\nBeyond the operating room, neuraxial techniques offer postoperative analgesia, improved pulmonary outcomes, and reduced thromboembolic risk.<sup>[11](https://link.springer.com/chapter/10.1007/978-3-032-16811-5_15)</sup> Compared with general anesthesia, neuraxial anesthesia may lower deep venous thrombosis and pulmonary embolism risk, though this advantage has diminished with routine pharmacologic prophylaxis <sup>[1](https://www.uptodate.com/contents/overview-of-neuraxial-anesthesia)</sup>; higher-risk patients with ischemic heart disease show fewer pulmonary complications and faster return of intestinal function with epidural anesthesia.<sup>[12](https://www.ncbi.nlm.nih.gov/books/NBK542219/)</sup> Against peripheral nerve blocks, meta-analysis shows thoracic epidurals give superior analgesia to paravertebral blocks, intercostal blocks, and intravenous analgesia for rib fractures.<sup>[19](https://asra.com/news-publications/asra-newsletter/newsletter-item/asra-news/2024/11/06/nerve-blocks-under-general-anesthesia-safety-versus-benefits)</sup>\n\n## Limitations and alternatives\n\n**Hypotension** is the common side effect, from decreased systemic vascular resistance and peripheral blood pooling <sup>[1](https://www.uptodate.com/contents/overview-of-neuraxial-anesthesia)</sup>; estimates range from as many as 47% of spinal anesthetics overall <sup>[1](https://www.uptodate.com/contents/overview-of-neuraxial-anesthesia)</sup> to 80–90% in elective cesarean parturients versus 25–75% in the general population.<sup>[5](https://www.dovepress.com/effects-of-hyperbaric-and-isobaric-bupivacaine-on-hemodynamic-profiles-peer-reviewed-fulltext-article-JPR)</sup> **Post-dural puncture headache** reaches 25% in some studies <sup>[3](https://www.ncbi.nlm.nih.gov/books/NBK537299/)</sup>; a 1953 study of a pencil-point design reported PDPH in 6.6% versus 22% with cutting-tip needles.<sup>[20](https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2004.03976.x)</sup> High or total block occurs in 1 in 4,336 obstetric [neuraxial blocks](https://www.edgepedia.org/neuraxial-block).<sup>[1](https://www.uptodate.com/contents/overview-of-neuraxial-anesthesia)</sup> Spinal failure rates of 1–17% have been reported, with major studies at 2–4%.<sup>[13](https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.937963/full)</sup>\n\n**Hematoma estimates vary widely by population, technique, and era.** Traditional figures were below 1 in 150,000 epidural and 1 in 220,000 spinal anesthetics before routine thromboprophylaxis <sup>[7](https://www.swa10.com/uploads/6/1/4/3/61438899/anticoag___regional.asra.2024.pdf)</sup>; a Swedish survey of 1,260,000 spinals and 45,000 epidurals found 33 spinal hematomas, 25 associated with an epidural technique <sup>[7](https://www.swa10.com/uploads/6/1/4/3/61438899/anticoag___regional.asra.2024.pdf)</sup>; risk was 1 in 200,000 in obstetric epidural analgesia versus 1 in 3,600 in elderly knee arthroplasty patients <sup>[7](https://www.swa10.com/uploads/6/1/4/3/61438899/anticoag___regional.asra.2024.pdf)</sup>; NAP3 found 0.85 per 100,000 <sup>[6](https://esraeurope.org/wp-content/uploads/2021/01/UK_Regional_anaesthesia_abnormalities_coagulation.pdf)</sup>; and ASRA notes the frequency may reach 1 in 3,000 in some patient populations.<sup>[21](https://rapm.bmj.com/content/35/1/64-101)</sup> Epidural catheter removal is the time of greatest hematoma risk, and suspected hematoma or abscess demands urgent MRI and neurosurgical discussion; the lowest effective local anesthetic concentration should be used to preserve motor function as a warning sign.<sup>[22](https://fpm.ac.uk/sites/fpm/files/documents/2026-04/Management%20of%20epidural%20analgesia%202025%20-2026%20update.pdf)</sup>\n\n**Contraindications.** Absolute: lack of patient consent, elevated intracranial pressure primarily from intracranial mass, and infection at the procedure site; relative: thrombocytopenia or coagulopathy, severe mitral or aortic stenosis, and left ventricular outflow obstruction.<sup>[3](https://www.ncbi.nlm.nih.gov/books/NBK537299/)</sup> Clinically significant systemic sepsis is a relative contraindication, and disseminated intravascular coagulation is incompatible with safe neuraxial blockade.<sup>[6](https://esraeurope.org/wp-content/uploads/2021/01/UK_Regional_anaesthesia_abnormalities_coagulation.pdf)</sup> Neuraxial procedures should be performed rarely in adults whose sensorium is compromised by general anesthesia or deep sedation.<sup>[19](https://asra.com/news-publications/asra-newsletter/newsletter-item/asra-news/2024/11/06/nerve-blocks-under-general-anesthesia-safety-versus-benefits)</sup>\n\n**Anticoagulation timing dominates practice.** Patients on unfractionated heparin 7,500–10,000 units twice daily require a 4–12 hour delay; warfarin must be withheld 5 days with an INR ≤1.4 documented.<sup>[12](https://www.ncbi.nlm.nih.gov/books/NBK542219/)</sup> DOAC resumption is delayed 24 hours after low or moderate bleeding-risk procedures and 48–72 hours after high-risk ones, and idarucizumab is not FDA-approved for reversing dabigatran before neuraxial interventions.<sup>[7](https://www.swa10.com/uploads/6/1/4/3/61438899/anticoag___regional.asra.2024.pdf)</sup> Current guidance rests on the 2025 ASRA fifth-edition guidelines <sup>[11](https://link.springer.com/chapter/10.1007/978-3-032-16811-5_15)</sup> and a joint ESAIC/ESRA guideline that formulated 40 statements by Delphi process; its time intervals are not modified by ultrasound guidance, drug combinations, or bleeding risk scores. UK practice now requires NRFit (ISO 80369-6) neuraxial connectors to prevent wrong-route connections <sup>[22](https://fpm.ac.uk/sites/fpm/files/documents/2026-04/Management%20of%20epidural%20analgesia%202025%20-2026%20update.pdf)</sup>, and a 2023 multisociety consensus addresses post-dural puncture headache management.<sup>[11](https://link.springer.com/chapter/10.1007/978-3-032-16811-5_15)</sup>\n\n## References\n\n1. [Overview of neuraxial anesthesia (UpToDate)](https://www.uptodate.com/contents/overview-of-neuraxial-anesthesia)\n2. [Neuraxial anesthesia and pain management for cesarean delivery (AJOG, 2025)](https://www.ajog.org/article/S0002-9378%2825%2900334-5/fulltext)\n3. [Spinal Anesthesia (StatPearls, NCBI Bookshelf)](https://www.ncbi.nlm.nih.gov/books/NBK537299/)\n4. [Modern neuraxial labor analgesia: techniques, pharmacologic strategies, and maternal–fetal outcomes](https://anesth-pain-med.org/journal/view.php?number=1370)\n5. [Effects of Hyperbaric and Isobaric Bupivacaine on Hemodynamic Profiles (RCT, 64 parturients)](https://www.dovepress.com/effects-of-hyperbaric-and-isobaric-bupivacaine-on-hemodynamic-profiles-peer-reviewed-fulltext-article-JPR)\n6. [Regional anaesthesia and patients with abnormalities of coagulation (UK/ESRA consensus guideline)](https://esraeurope.org/wp-content/uploads/2021/01/UK_Regional_anaesthesia_abnormalities_coagulation.pdf)\n7. [ASRA practice recommendations on regional anesthesia in patients receiving antithrombotic/thrombolytic therapy (2024 edition text)](https://www.swa10.com/uploads/6/1/4/3/61438899/anticoag___regional.asra.2024.pdf)\n8. [Neuraxial Blocks: Spinal and Epidural Anesthesia (Anesthesia Key)](https://aneskey.com/neuraxial-blocks-spinal-and-epidural-anesthesia/)\n9. [Hyperbaric Spinal Ropivacaine for Cesarean Delivery: A Comparison to Hyperbaric Bupivacaine](https://journals.lww.com/anesthesia-analgesia/fulltext/2001/07000/hyperbaric_spinal_ropivacaine_for_cesarean.31.aspx)\n10. [Sensory block level prediction of spinal anaesthesia with 0.5% hyperbaric bupivacaine: a retrospective study | Scientific Reports](https://www.nature.com/articles/s41598-021-88726-2)\n11. [Neuraxial Anesthesia: Spinal, Epidural, and Combined Techniques (Springer chapter, 2026)](https://link.springer.com/chapter/10.1007/978-3-032-16811-5_15)\n12. [Epidural Anesthesia (StatPearls, NCBI Bookshelf)](https://www.ncbi.nlm.nih.gov/books/NBK542219/)\n13. [Comparison between 10 and 12 mg doses of intrathecal hyperbaric (0.5%) bupivacaine on sensory block level after first spinal failure in cesarean section: A double-blind, randomized clinical trial](https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.937963/full)\n14. [August Bier (1899). Versuche über Cocainisirung des Rückenmarkes. Deutsche Zeitschrift für Chirurgie.](https://doi.org/10.1007/bf02792160)\n15. [DUDLEY TAIT (1900). EXPERIMENTAL AND CLINICAL NOTES ON THE SUBARACHNOID SPACE.. JAMA.](https://doi.org/10.1001/jama.1900.24620270006001a)\n16. [Manual Martinez Curbelo (1949). Continuous Peridural Segmental Anesthesia by Means of a Ureteral Catheter.. Anesthesia & Analgesia.](https://doi.org/10.1213/00000539-194901000-00002)\n17. [Combined spinal–epidural techniques (Anaesthesia review)](https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1046/j.1365-2044.2000.01157.x)\n18. [Current status of the combined spinal-epidural technique in obstetrics and surgery](https://www.sciencedirect.com/science/article/abs/pii/S1521689623000228)\n19. [Nerve Blocks Under General Anesthesia: Safety Versus Benefits (ASRA News, 2024)](https://asra.com/news-publications/asra-newsletter/newsletter-item/asra-news/2024/11/06/nerve-blocks-under-general-anesthesia-safety-versus-benefits)\n20. [The history of spinal needles: getting to the point (Anaesthesia, 2004)](https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2004.03976.x)\n21. [Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: ASRA Evidence-Based Guidelines (Third Edition), Horlocker et al., Reg Anesth Pain Med 2010](https://rapm.bmj.com/content/35/1/64-101)\n22. [Best practice in the management of epidural analgesia in the hospital setting (Faculty of Pain Medicine, RCoA, 2025–2026 update)](https://fpm.ac.uk/sites/fpm/files/documents/2026-04/Management%20of%20epidural%20analgesia%202025%20-2026%20update.pdf)\n\n---\n*Topic: Encyclopedia › Life and health › Human health and medicine › Clinical assessment and procedures › Anesthesiology and perioperative care › Neuraxial anesthesia and analgesia*\n\n*Initially written Sep 29, 2026 · Edited: Oct 15, 2026*\n\n*Copyright 2026 EdgeChat AI, a subsidiary of Biostate AI.*\n\nLicense: Edgepedia Community License 1.0, https://www.edgepedia.org/edgepedia/license\n",
 "same_as": [],
 "url": "https://www.edgepedia.org/neuraxial-anesthesia",
 "markdown_url": "https://www.edgepedia.org/neuraxial-anesthesia.md",
 "license": {
  "name": "Edgepedia Community License 1.0",
  "url": "https://www.edgepedia.org/edgepedia/license",
  "summary": "Free with credit, commercial use included. AI training is open to everyone. For other uses, organizations over USD 100M in revenue or 100M monthly users license separately.",
  "spdx": "LicenseRef-Edgepedia-Community-1.0"
 },
 "credit": "\"Neuraxial anesthesia\", Edgepedia (EdgeChat), https://www.edgepedia.org/neuraxial-anesthesia. Edgepedia Community License 1.0.",
 "credit_md": "\"[Neuraxial anesthesia](https://www.edgepedia.org/neuraxial-anesthesia)\", Edgepedia (EdgeChat), [https://www.edgepedia.org/neuraxial-anesthesia](https://www.edgepedia.org/neuraxial-anesthesia). [Edgepedia Community License 1.0](https://www.edgepedia.org/edgepedia/license).",
 "credit_html": "\"<a href=\"https://www.edgepedia.org/neuraxial-anesthesia\">Neuraxial anesthesia</a>\", Edgepedia (EdgeChat), <a href=\"https://www.edgepedia.org/neuraxial-anesthesia\">https://www.edgepedia.org/neuraxial-anesthesia</a>. <a href=\"https://www.edgepedia.org/edgepedia/license\">Edgepedia Community License 1.0</a>.",
 "speakable": "Neuraxial anesthesia is regional anesthesia injected near the spinal cord, comprising single-injection spinal anesthesia and catheter-based epidural anesthesia, used for labor analgesia and as the standard anesthetic for cesarean delivery."
}
