Combined spinal-epidural versus spinal anaesthesia for caesarean section

Simmons, S. W.; Dennis, A.T.; Cyna, Allan M; Richardson, Matthew; Bright, Matthew

doi:10.1002/14651858.cd008100.pub2

Cited by 16 publications

(7 citation statements)

References 42 publications

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“…Consequently, the authors concluded that there is insufficient evidence to support one technique over the other, and more studies are needed to further assess the relative safety of CSE and spinal anesthesia for cesarean section. 23 Hence, for this situation, spinal anesthesia was deemed an acceptable technique.…”

Section: Discussionmentioning

confidence: 99%

Emergency Cesarean Section in a Parturient with Ruptured Sinus of Valsalva under Spinal Anesthesia: A Case Report

Cruz, MD,

Cruz, MD, MS ClinEpi

2024

Acta Med Philipp

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Ruptured Sinus of Valsalva (RSOV) is a rarely encountered cardiac anomaly that can potentially lead to adverse clinical outcomes. RSOV increases the risk of morbidity during pregnancy due to the physiological changes associated with gestation, that can exacerbate the underlying cardiac pathology. We present the case of a 29-year-old female with an uncorrected RSOV who required an emergency cesarean section for abruptio placenta. The patient underwent the procedure under spinal anesthesia, with careful titration of norepinephrine infusion and close monitoring of hemodynamic parameters using an invasive intra-arterial line. Given the absence of established anesthetic protocols for parturients with RSOV undergoing cesarean delivery, a comprehensive understanding of the complex interaction between the hemodynamic effects of RSOV, pregnancy, and anesthesia is essential. This understanding enables the safe use of spinal anesthesia in urgent situations, leading to favorable patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Emergency Cesarean Section in a Parturient with Ruptured Sinus of Valsalva under Spinal Anesthesia: A Case Report

Cruz, MD,

Cruz, MD, MS ClinEpi

2024

Acta Med Philipp

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“…Compared with the participants in the lumbar PCEA group, those in the low thoracic PCEA group requested significantly fewer doses with respect to patient-controlled demand (low thoracic PCEA group, 9 (4-25); lumbar PCEA group, 21 (9-37); p = 0.007) and delivery (low thoracic PCEA group, 7 (2-18); lumbar PCEA group, 11 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25); p = 0.002) doses. The low thoracic PCEA group had a comparable demand/delivery ratio to the lumbar PCEA group (p = 0.371; Table 4).…”

Section: Analgesic Requirementmentioning

confidence: 94%

“…Inadequate postcesarean pain management is associated with multiple negative maternal effects such as delayed postpartum recovery [3,4], interference with breastfeeding [5], and a high risk of postpartum depression and persistent pain [6]. Epidural analgesia achieves better analgesic effects than do parenteral opioids in the surgical population [7], and combined spinal-epidural anesthesia is regarded as a suitable option for cesarean delivery [8,9]. Therefore, epidural analgesia may play a key role in optimizing postcesarean pain management; however, the related mechanism has not been sufficiently explored.…”

Section: Introductionmentioning

confidence: 99%

Influence of Catheter–Incision Congruency in Epidural Analgesia on Postcesarean Pain Management: A Single-Blinded Randomized Controlled Trial

Chen

Chou

Yie

et al. 2021

JPM

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Patient-controlled epidural analgesia (PCEA) or epidural morphine may alleviate postcesarean pain; however, conventional lumbar epidural insertion is catheter–incision incongruent for cesarean delivery. Methods: In total, 189 women who underwent cesarean delivery were randomly divided into four groups (low thoracic PCEA, lumbar PCEA, low thoracic morphine, and lumbar morphine groups) for postcesarean pain management. Pain intensities, including static pain, dynamic pain, and uterine cramp, were measured using a 100 mm visual analog scale (VAS). The proportion of participants who experienced dynamic wound pain with a VAS score of >33 mm was evaluated as the primary outcome. Adverse effects, including lower extremity blockade, pruritus, postoperative nausea and vomiting, sedation, and time of first passage of flatulence, were evaluated. Results: The low thoracic PCEA group had the lowest proportion of participants reporting dynamic pain at 6 h after spinal anesthesia (low thoracic PCEA, 28.8%; lumbar PCEA, 69.4%; low thoracic morphine, 67.3%; lumbar morphine group, 73.9%; p < 0.001). The aforementioned group also reported the most favorable VAS scores for static, dynamic, and uterine cramp pain during the first 24 h after surgery. Adverse effect profiles were similar among the four groups, but a higher proportion of participants in the lumbar PCEA group (approximately 20% more than in the other three groups) reported prolonged postoperative lower extremity motor blockade (p = 0.005). In addition, the first passage of flatulence after surgery reported by the low thoracic PCEA group was approximately 8 h earlier than that of the two morphine groups (p < 0.001). Conclusions: Epidural congruency is essential to PCEA for postcesarean pain. Low thoracic PCEA achieves favorable analgesic effects and may promote postoperative gastrointestinal recovery without additional adverse effects.

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“…[7–10,12,14–18,22,36] If CSEA is combined with low-dose spinal anesthesia, intraoperative epidural administration of a local anesthetic is a viable alternative strategy in achieving opioid-free anesthesia. [37]…”

Section: Clinical Implicationmentioning

confidence: 99%

Epidural administration of 2% Mepivacaine after spinal anesthesia does not prevent intraoperative nausea and vomiting during cesarean section: A prospective, double-blinded, randomized controlled trial

Kita¹,

Furutani

Baba

2022

Medicine

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Background: Intraoperative nausea and vomiting (IONV) is a common symptom during cesarean section (CS) delivery causing significant discomfort to patients. Combined spinal and epidural anesthesia (CSEA) can provide both intraoperative anesthesia and postoperative analgesia. During CSEA, it is reasonable to administer local anesthetics to the epidural space before patient complaints to compensate for the diminished effect of spinal anesthesia. Therefore, we hypothesized that intraoperative epidural administration of 2% mepivacaine would reduce the incidence of IONV.Methods: Patients who were scheduled for elective CS were randomly allocated to 2 groups. Patients and all clinical staff except for an attending anesthesiologist were blinded to the allocation. After the epidural catheter was inserted at the T11-12 or T12-L1 interspace, spinal anesthesia was performed at the L2-3 or L3-4 interspace to intrathecally administer 10 mg of 0.5% hyperbaric bupivacaine. Twenty min after spinal anesthesia, either 5 mL of 2% mepivacaine (group M) or saline (group S) was administered through an epidural catheter. Vasopressors were administered prophylactically to keep both the systolic blood pressure ≥ 80 % of the baseline value with the absolute value ≥ 90 mm Hg and the mean blood pressure ≥ 60 mm Hg. The primary endpoint was the incidence of IONV. The secondary endpoints were degree of nausea, the degree and incidence of pain, and Bromage score.Results: Ninety patients were randomized, and 3 patients were excluded from the final analysis. There was no significant difference in the incidence of IONV between the groups (58% in group M and 61% in group S, respectively, P = .82). In contrast, the incidence and degree of intraoperative pain in group M were significantly lower compared to group S. In addition, the incidence of rescue epidural administration of fentanyl (18% vs 47%) or mepivacaine (2.3% vs 25%) for intraoperative pain was lower in group M compared to group S.Conclusions: Our results indicate that epidural administration of 2% mepivacaine 20 minutes after spinal anesthesia does not reduce the incidence of IONV in CS under CSEA. However, intraoperative epidural administration of 2% mepivacaine was found to improve intraoperative pain.

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Combined spinal-epidural versus spinal anaesthesia for caesarean section

Cited by 16 publications

References 42 publications

Emergency Cesarean Section in a Parturient with Ruptured Sinus of Valsalva under Spinal Anesthesia: A Case Report

Emergency Cesarean Section in a Parturient with Ruptured Sinus of Valsalva under Spinal Anesthesia: A Case Report

Influence of Catheter–Incision Congruency in Epidural Analgesia on Postcesarean Pain Management: A Single-Blinded Randomized Controlled Trial

Epidural administration of 2% Mepivacaine after spinal anesthesia does not prevent intraoperative nausea and vomiting during cesarean section: A prospective, double-blinded, randomized controlled trial

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