Comparison of the maternal and neonatal effects of combined spinal-epidural block and spinal block for cesarean section

Abstract

Objectives: Combined spinal-epidural block (CSEB) has gained increasing interest as it combines the reliability of a spinal block (SB) and the flexibility of an epidural block in cesarean section. We have investigated maternal and fetal effect of CSEB against SB in cesarean operation.
Material and Methods: Forty healty, term pregnant women were randomized into two groups. Patients in the CSEB and SB groups were given 1.5 mL and 2.5 mL of 0.5% hyperbaric bupivacaine intrathecally, respectively. If sensorial block did not reach T4 within 10 min, supplemental bupivacaine was injected epidurally 2 mL per unblocked segment in CSEB group. The quality and side effects of surgical anesthesia, hemodynamic parameters, Apgar scores, NACS and postoperative duration of pain were compared between the two groups.
Results: The time for the block to rich T4 level was significantly lower in SB group (p<0.05). More patients in the SB group achieved complete motor blockade sooner than in the CSEB group (p<0.05). Mean arterial pressure was lower in SB group (p<0.05). There were no significant differences between the groups in the incidences of apgar scores, cord blood gases, and NACS and adverse effects such as nausea and vomiting.
Conclusion: Both spinal and CSE block provide good surgical analgesia for cesarean section. Maternal hypotension is a risk with both technigues, but it occurs earlier and more higher with spinal block. There is no difference in neonatal outcome, provided that maternal blood pressure is cautiously monitored and hypotension promptly treated.