Combined low-dose spinal-epidural anesthesia versus single-shot spinal anesthesia for elective cesarean delivery

A randomized trial of crystalloid versus colloid solution for prevention of hypotension during spinal or low-dose combined spinal-epidural anesthesia for elective cesarean delivery

“…23 Our previous study of CSE anesthesia demonstrated that a lower spinal dose elevated the sensory block level more slowly, and hypotension and nausea occurred less frequently resulting in better hemodynamic stability than single-shot spinal anesthesia for cesarean delivery. 13 Similarly, Ben-David et al reported that this reduced intrathecal anesthetic requirement decreased the intensity and duration of sympathetic and motor blockade, and thus, lessened the severity of maternal hypotension. 24 In agreement with these studies, the results of our current study showed that the incidences of hypotension, nausea and vomiting in the CSE group using 0.5% bupivacaine 6 mg + fentanyl 20 lg were significantly lower than in the SA group.…”

“…Patients were then placed in the supine position with left uterine displacement using an airbag under the right hip; 5 min after the intrathecal injection, 0.25% bupivacaine 10 mL was given through the epidural catheter to all patients following the methods from our previous study. 13 Patients in the spinal group were given hyperbaric 0.5% bupivacaine 9 mg mixed with fentanyl 20 lg through a 27-gauge Sprotte needle (Pencan Ò , B.Braun, Melsungen, Germany) via a 22-gauge introducer after free flow of cerebrospinal fluid was observed. A sham epidural catheter as used in the CSE group was applied to the patient's back, and immediately after this, patients were turned supine with left uterine displacement.…”

O bloqueio combinado raqui-peridural com extensão do volume peridural causa nível mais alto de bloqueio do que a raquianestesia com dose única

“…When we have a look at the studies regarding application duration and cost of SSS and CSEA techniques, Choi et al compared CSEA versus SSS for cesarean section and concluded that anesthetic procedure time was signifi cantly longer in CSEA group (CSEA: 4.6 ± 1.6 min). Although time difference between the two techniques is considered statistically signifi cant, in cases of elective cesarean section the CSEA technique can overcome the limits connected with the SSS technique 23,24 . Edward et al retrospectively reviewed the chars of patients who had received epidural or spinal anesthesia for non-emergent cesarean section.…”

Challenges in obstetric anesthesia and analgesia

“…16 Anesthesiologists are investigating many aspects of anesthetic technique for Cesarean delivery in order to reduce the high incidence of hypotension with spinal anesthesia at Cesarean delivery. Practices that have been investigated include: using low dose spinal bupivacaine with relatively high dose fentanyl 17 or a combined spinal-epidural technique; 18 varying the speed of injection; 19 administering vasopressors prophylactically, 15,20,21 and providing fluid loading. 21 More sophisticated models have been proposed, such as using baseline heart rate 22 or heart rate variability 23 to anticipate hypotension, or dural sac dimensions to predict spread of local anesthetic.…”