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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
ORIGINAL ARTICLES ANESTHESIOLOGY
Minerva Anestesiologica 1998 September;64(9):387-91
Epidural versus spinal anesthesia for cesarean section. A prospective clinical trial
Albani A., Renghi A., Ciarlo M., Avallone V., Toscano M.
Ospedale Regionale della Valle d’Aosta - Aosta, Unità Operativa di Anestesia e Terapia Intensiva
Objective.To compare technical and clinical differences between epidural and spinal anesthesia for cesarean section.
Study design. Randomized prospective trial.
Patients and methods. 64 pregnant women at term scheduled for elective cesarean section. Two groups were randomized: A) PD Group (n=32): continuous epidural anesthesia by administration of bupivacaine 0.5% plus epi-nephrine 1/400000 via an epidural catheter. Epidural morphine 3 mg was administered at the end of surgery. B) SP Group (n=32): “single shot” spinal anesthesia by intrathecal administration of hyperbaric 1% bupivacaine 1-1.4 ml plus morphine 0.2 mg. The pin prick block level reached T2-T6 at incision time.
Data collection. 1) Time from the beginning of anesthesia to surgical incision. 2) Hypotension episodes. 3) Ephedrine consumption. 4) Intraoperative discomfort at delivery, traction and uterine manipulation, peritoneal toilette. 5) Nausea and vomiting. 6) Apgar score. 7) Postoperative headache.
Results. Women in the SP group had more hypotensive episodes (81% vs 53%: p<0.05) and more ephedrine consumption with a large individual variability (29.12 mg±20.4 vs 12.83±13.8: p<0.01) when compared to PD group, without any difference in the Apgar score. The SP group required less time consumption (10.5 min.±6.7 vs 35.9 min.±17.3: p<0.01) and had less intraoperative discom-fort with less analgesic and/or sedative drugs consumption (9.7% vs 29%: p<0.05) and less vomiting (3% vs 22.5%: p<0.05). No postoperative headache was noticed in both groups.
Conclusions. With the described pharmacological and technical approach, spinal anesthesia is more suitable than continuous epidural technique for cesarean section, unless contraindicated.