Objective: To find out a simple, safe and low cost technique of CESA

Materials& Methods:Freely moving dry autoclaved 5ml glass syringe, Rubber band taken from 6” gloves, 27G Spinal Needle, 20G IV Canulla, 16G Epidural Needle.

Procedures: Patient is positioned and a suitable inter-spinal space is identified with 2ml of 1% lignocane. The epidural needle is introduced up to the ligamentumflavum. Then the glass syringe with the elastic rubber band stretched over it and loaded with 2cc of air is fixed to the hub of the epidural needle. The epidural needle with the air loaded syringe is slowly advanced. As soon as the tip of the epidural needle pierces the ligamentumflavum, air in the syringe will be rapidly emptied into the epidural space pushing away the dura. You can withdraw the air from the epidural space and confirm the identificationof the epidural space. The combined epidural spinal needle made by me is introduced through the spinal needle to pierce the dura and local anaesthetic solution is injected (The combined epidural spinal needle is made by 27G spinal needle after removing the plastic hub and introducing it into the stillet of 20G IV canulla and fixing it with glue. This is cleaned, autoclaved and used)

Result: Total No. of cases - 4440 Period of study: January 2000 to July 2014 LSCS - 2437 Hysterectomy - 1196 Laparoscopy - 807

Complications: Dural puncture - 4 cases

Conclusion: This is very safe and useful technique with very high success rate especially for low resource set up.

Dr.VasudevaPanicker DA, MD, DGO Mob: 9447351590 PANICKER’S HOSPITAL Web: www.drpanicker.com KODUNGALLUR-680664 Email: drvpanicker@gmail.com THRISSUR, KERALA.