Epidural versus combined spinal epidural block for cesarean section

Abstract

In a controlled study a single segment combined spinal epidural (CSE) block was compared with epidural block for cesarean section. Thirty healthy parturients were randomly divided into two groups. In both groups a T4 block was aimed at. Bupivacaine was used to provide analgesia in both groups. All patients receiving CSE block had good to excellent analgesia, while 11 patients (74%) receiving epidural block had similar pain relief. This was reflected in the requirement for additional analgesics, sedatives or N2O anesthesia. The muscular relaxation was also better following CSE block. The total dose of bupivacaine for a T4 block was three times larger in patients receiving only epidural block. The maternal and fetal blood bupivacaine levels were correspondingly about three times higher in the epidural group. Additionally, the incidence of maternal hypotension was higher in patients receiving epidural block. Apgar scores, blood gases and neurobehavioural evaluation did not show any differences between the two groups of neonates. No postspinal headache was noted. CSE block appears to combine the reliability of spinal block and the flexibility of epidural block while minimizing their drawbacks.

PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies

“…10,20,25,29,46 Therefore, the data were not pooled. With the exception of one study, 46 these studies examined few (15 to 35) patients and reported no events.…”

“…Thirty-nine studies (16 RCT, [10][11][12]14,[16][17][18][19][20][21]23,24,26,[28][29][30] ten cohort studies, [33][34][35][36][38][39][40][41][42][43] and 13 case series 45,[47][48][49][50][51][53][54][55][56][57][58][59][60] ) contained data on frequency of ADP or PDPH (Table I). Figures 1 to 3 summarize the meta-analyses of ADP and PDPH risks for different epidural and spinal needles.…”

Effect of Clonidine and/or Fentanyl in Combination with Intrathecal Bupivacaine for Lower Limb Orthopedic Surgeries in Spinal Anaesthesia

“…Sympathetic block generally extends 2-6 dermatomes above the sensorial blockade . 4,5 Various additives have been evaluated in the quest for an ideal adjuvant, which can enhance the quality of analgesia and prolong the duration of spinal anesthesia with minimal adverse effects. However, success with many additives has been variable, especially with regards to side-effects such as hypotension, bradycardia, pruritus, respiratory depression, nausea, vomiting, and urinary retention.…”

Combined spinal-epidural anesthesia for Cesarean section in a patient with peripartum dilated cardiomyopathy

“…First, CSE has a lower failure rate than EA. 13 Secondly, intra-operative patient satisfaction, anxiolysis, and post-operative pain scores have been superior with CSE. 1 4 Furthermore, some authors report a lower incidence of hypotensive episodes with CSE compared to EA.…”