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

Abstract

Background: Combined spinal-epidural block (CSEB) has aroused increasing interest, as it combines the reliability of a spinal block and the flexibility of an epidural block (EB). We have conducted a comparative investigation of the maternal and fetal effects of CSEB and of EB administered for Cesarean section.

Methods: Eighty pregnant women at term were randomized into two groups. Women in the CSEB group (N = 40) were each given 1.5-1.8 mL 0.5% hyperbaric bupivacaine intrathecally, followed by 10 mL 0.25% bupivacaine and 50 microg fentanyl through the epidural catheter 10 min later. Women in the EB group (N = 40) received 14-16 mL 0.5% bupivacaine and 100 microg fentanyl. The quality and side effects of surgical anesthesia and the hemodynamic parameters, Apgar scores, and postoperative duration of pain were compared between the two groups.

Results: The time for the block to reach the T-4 level differed significantly between the two groups (8.02 +/- 3.4 versus 18.34 +/- 4.6; P < 0.01). More women in the CSEB group achieved complete motor blockade (Bromage score 3), and it was reached earlier than in the EB group (P < 0.05). Muscle relaxation and motor block were better in the CSEB group than in the EB group (P < 0.01). Apgar scores were 7 or more in almost all newborns in both groups. There were no significant differences between the groups in the incidences of adverse effects such as hypotension or nausea and vomiting, but the patients in the EB group experienced more shivering (P < 0.001). The time to postoperative pain was significantly shorter in the CSEB group.

Conclusion: We decided that CSEB, and more specifically spinal anesthesia with supporting epidural anesthesia, has greater efficacy and fewer side effects than EB when administered for Cesarean section.