Randomised controlled trial of combined spinal epidural vs. spinal anaesthesia for elective caesarean section: vasopressor requirements and cardiovascular changes

Macfarlane, Alan; Pryn, A.; Litchfield, K.; Bryden, F.; Young, Steven J.; Weir, Christopher J.; McGrady, Elizabeth

doi:10.1097/eja.0b013e328319c153

Cited by 6 publications

(4 citation statements)

References 32 publications

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“…However, use of smaller doses decreases the duration of anaesthesia and may necessitate the use of a combined spinal-epidural (CSE) technique [9]. Although it has previously been proposed that the CSE technique itself may be associated with higher blocks versus single-shot spinal anaesthesia using equivalent doses, this finding was not reproduced in two recent studies [10,11].…”

Section: Risk Factorsmentioning

confidence: 99%

Prevention of maternal hypotension after regional anaesthesia for caesarean section

Kee

2010

Current Opinion in Anaesthesiology

132

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Section: Risk Factorsmentioning

confidence: 99%

Prevention of maternal hypotension after regional anaesthesia for caesarean section

Kee

2010

Current Opinion in Anaesthesiology

132

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“…Numerous previous studies have confirmed the benefits of spinal anesthesia for cesarean section in comparison to general anesthesia. The results of these studies indicate greater safety for mother and child, lower likelihood of complications, less blood loss, and better mother and baby survival [10][11][12][13][14][15][16] . However, recent developments in pain treatment are more commonly investigated for the occurrence of chronic pain.…”

Section: Discussionmentioning

confidence: 99%

Level of Pain and Analgesics Taken after Cesarean Section and Differences According to Type of Anesthesia and Demographic Factors

Andrić

2022

ACC

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the period from September 2015 to June 2016. The study included 111 puerperas. Experimental group included 54 puerperas operated on under spinal anesthesia, while comparative group included 57 puerperas operated on under general anesthesia. Primary endpoints of the study were pain score and dose number of analgesics used. Input parameters of the study were age, gestational age, education, and place of residence. To determine the level of pain, visual analog scale for pain was used. Results showed that puerperas operated on under spinal anesthesia had significantly lower pain sensation (p=0.031) and less need for analgesic consumption in the postoperative period as compared to those operated on under general anesthesia (p=0.024). Increased age was associated with lower pain sensation (p=0.014) and need for analgesics (p<0.05). Higher level of education was associated with greater need for analgesics (p=0.016). Living in urban area was associated with greater pain sensation (p=0.023) and less need for analgesics (p<0.17). Spinal anesthesia for cesarean section resulted in less pain and less need for analgesics in the postoperative period compared to general anesthesia.

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“…In agreement with the results of the present analysis, Horstman et al also demonstrated a similar blockade associated with CSEA and SSSA among 30 parturients (18–45 years old) who underwent elective cesarean delivery [17], and they also showed no significant differences in median pinprick sensory block height (T4 [T4-2] and T3 [T4-1]) or cerebrospinal fluid pressures. In addition, Macfarlane et al showed CSEA placement was not associated with hemodynamic advantages when compared to SSSA, even when the same dose of local anesthetic agent was administered [18]. In their study, hyperbaric bupivacaine (12.5 mg) and diamorphine (0.3 mg) were administered intrathecally via CSEA or SSSA in 70 women who underwent cesarean delivery.…”

Section: Discussionmentioning

confidence: 99%

Combining Spinal-Epidural Anesthesia versus Single-Shot Spinal Anesthesia for Cesarean Delivery: A Meta-Analysis of 5 Randomized Controlled Trials

Jing

Wang

2019

Med Sci Monit

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Background This study compared combined spinal-epidural anesthesia (CSEA) and single-shot spinal anesthesia (SSSA) by performing a meta-analysis. Material/Methods An electronic search of relevant studies was done through 2017. Primary endpoints included duration of surgery, and time for (1) sensory recovery to thoracic vertebra (T10), (2) maximal sensory, (3) motor blockade, and (4) motor recovery. Secondary endpoints were the adverse effects. RevMan 5.3 analytical software was used with odds ratios (OR) and 95% confidence intervals (CIs) as the analytic parameters. Standard deviation and mean were used to evaluate data by weighted mean differences (WMDs) with 95% CI. Results A total of 370 patients were analyzed. A similar duration of surgery was observed with CSEA and SSSA (WMD: 0.24, 95%CI: −3.41–3.89; P=0.90). Time to maximal sensory blockade (WMD: 0.96, 95%CI: −2.91–4.83), time to maximal motor blockade (WMD: 0.25, 95%CI: −2.46–2.96), time for complete motor recovery (WMD: −6.28, 95%CI: −29.42–16.86), and time for sensory recovery to T10 vertebra (WMD: 0.42, 95%CI: −11.07–11.91) were not significantly different. Adverse effects such as hypotension (OR: 1.49, 95%CI: 0.27–8.31), pruritus (OR: 0.23, 95%CI: 0.03–2.18), nausea/vomiting (OR: 0.84, 95%CI: 0.12–5.99). and shivering (OR: 0.53, 95%CI: 0.11–2.56) were also similar with CSEA and SSSA. Conclusions CSEA was not associated with significantly different maximal duration of sensory/motor blockade, complete motor recovery, sensory regression to T10, or adverse drug events compared to SSSA. Hence, both should be considered effective in cesarean delivery.

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Randomised controlled trial of combined spinal epidural vs. spinal anaesthesia for elective caesarean section: vasopressor requirements and cardiovascular changes

Abstract: CSEA placement appears to offer no haemodynamic benefits compared with SSSA when the same dose of local anaesthetic is administered.

Cited by 6 publications

References 32 publications

Prevention of maternal hypotension after regional anaesthesia for caesarean section

Prevention of maternal hypotension after regional anaesthesia for caesarean section

Level of Pain and Analgesics Taken after Cesarean Section and Differences According to Type of Anesthesia and Demographic Factors

Combining Spinal-Epidural Anesthesia versus Single-Shot Spinal Anesthesia for Cesarean Delivery: A Meta-Analysis of 5 Randomized Controlled Trials

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