Over the last two decades there has been considerable revival of interest in and use of regional anesthesia techniques for surgery and pain management. New drugs, new needle designs, and developments in catheter technology have contributed to improving the quality and safety of regional anesthesia. Several modifications of blockade techniques have been described to improve the efficacy and safety of brachial plexus, femoral, sciatic, and other peripheral nerve blocks. New regional anesthesia techniques, such as interpleural, intra-articular, and combined spinal epidural (CSE) anesthesia and analgesia, have been introduced in recent years.

The CSE technique has attained widespread popularity for patients undergoing major surgery below the umbilical level who require prolonged and effective postoperative analgesia. Epiduroscopy and spinaloscopy, as well as the newer radiologic imaging techniques, have revealed new insights of anatomic structures in the lumbar epidural and subarachnoid areas, thus improving the performance and safety of central regional blocks. The CSE technique is now well established in many institutions. This article includes the clinical experience, advantages, and potential problems, and points out some future perspectives of the CSE technique.