Continuous Spinal Anesthesia (CSA)

Regional anesthesia has several benefits over general anesthesia for orthopedic surgery [1]. Continuous spinal anesthesia (CSA) is the procedure of providing and maintaining spinal anesthesia by small doses of local anesthetic which are injected repeatedly as needed into the subarachnoid space through an indwelling catheter [2].Continuous spinal anesthesia (CSA) has been accepted as a reliable method for high-risk patients, it provides a higher control of local anesthetic spread over both loading and maintenance doses, with a more expected effect and lesser cardiovascular and pulmonary consequences [3].
Epidural anesthesia in opposition to spinal anesthesia is technically more complex, less reliable and needs a higher pharmacological dose of local anesthetics; causing systemic toxicity a matter. Also, epidural anesthesia provides some benefits; foremost among them is the low risk of post-dural puncture headache (PDPH), which makes it a proper option for both young and old patients [4]
A unique catheter-over-needle design has been produced to reduce the difficulties and complications of continuous spinal anesthesia with microcatheters [6], which involve difficult catheter insertion, breakage, poor anesthesia, (PDPH), and, infrequently, development of cauda equina syndrome