Comparison between general, spinal, epidural, and combined spinal-epidural anesthesia for cesarean delivery: a network meta-analysis

Abstract

Background: This study is a network meta-analysis to compare maternal and fetal outcomes associated with four different anesthetic techniques for cesarean delivery. Methods: An arm-based, random-effects frequentist network meta-analysis was performed. A random effect model was selected considering deviance information criteria. Randomized trials reporting the following outcomes were included: Apgar score at 1-or 5-min; umbilical arterial and venous pH; umbilical arterial pH <7.2; and neonatal score at 2-4 hours. Loop-specific heterogeneity was evaluated by risk of odds ratio and s 2. Quality of evidence was assessed using the GRADE approach. Results: Data from 46 randomized trials including 3689 women contributed to the study. There were significant differences in Apgar score 6 at 1 min between spinal versus general anesthesia (odds ratio 0.27, 95% confidence interval [CI] 0.13 to 0.55: moderate quality evidence) and Apgar scores at 1-and 5-min, favoring spinal anesthesia. Umbilical venous pH associated with epidural anesthesia was significantly higher than that with general anesthesia (mean difference 0.010, 95% CI 0.001 to 0.020: moderate quality evidence) or spinal anesthesia. Spinal anesthesia was ranked best for Apgar score 6 at 1-min (SUCRA=89.8), Apgar score at 1-min (SUCRA=80.4) and 5-min (SUCRA=90.5). Epidural anesthesia was ranked highest for umbilical venous pH (SUCRA=87.4) and neonatal score (SUCRA=79.3). Conclusions: Spinal and epidural anesthesia were ranked high regarding Apgar scores and epidural anesthesia was ranked high regarding umbilical venous pH, but the results were based on small heterogeneous studies with high or unclear risks of bias.

The efficacy and safety of intrathecal dexmedetomidine for parturients undergoing cesarean section: a double-blind randomized controlled trial

“…Spinal anesthesia, with the advantage of easy-operating and avoiding the maternal risk of general anesthesia, including tracheal intubation failure, aspiration and lung infection, has been recommended as the preferred anesthesia for cesarean section [1][2][3][4]. However, some disadvantages caused by single-shot spinal anesthesia such us the limited duration of action and insufficient postoperative analgesia, which will lower the maternal postoperative recovery quality, and increasing local anesthetics doses is prone to cause maternal and neonatal adverse events [5,6].…”

The efficacy and safety of intrathecal dexmedetomidine for parturients undergoing cesarean section: a double-blind randomized controlled trial

“…Spinal anesthesia, with the advantage of easy-operating and avoiding the maternal risk of general anesthesia, including tracheal intubation failure, aspiration and lung infection, has been recommended as the preferred anesthesia for cesarean section [1][2][3][4] . However, some disadvantages caused by single-shot spinal anesthesia such us the limited duration of action and insu cient postoperative analgesia, which will lower the maternal postoperative recovery quality, and increasing local anesthetics doses is prone to cause maternal and neonatal adverse events [5,6] .…”

The efficacy and safety of intrathecal dexmedetomidine for parturients undergoing cesarean section: a double-blind randomized controlled trial

“…Spinal anesthesia, with the advantage of easy-operating and avoiding the risk of general anesthesia, including tracheal intubation failure, aspiration and lung infection, has been recommended as the preferred anesthesia for cesarean section [1][2][3] . However, some disadvantages caused by single spinal anesthesia such us the limited duration of action and insu cient postoperative analgesia, which will lower the maternal postoperative recovery quality, and increasing local anesthetics doses is prone to cause maternal and neonatal adverse events [4,5] .…”