Subarachnoid Versus Epidural Bupivacaine 0.5% for Caesarean Section

Helbo‐Hansen, S.; Bang, U.; Garcia, R. S.; Olsen, Adam S.; Kjeldsen, Lisbeth Stigaard

doi:10.1097/00132582-198904000-00032

Cited by 5 publications

(6 citation statements)

References 2 publications

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“…Table 2 gives details of included trials and Table 3 the excluded studies, with reasons for their exclusion and a summary of their neonatal findings. There were few randomised trials in the early years of the search, the first in 1988 [15]. In all, only 12 randomised trials were identified, of which two could not be included because standard deviations were not published or obtainable from the authors.…”

Section: Resultsmentioning

confidence: 99%

“…Among them are intravenous fluid loading, the use of vasopressors, maternal position or uterine displacement, the presence and extent of sympathetic blockade, inspired oxygen concentration, skin incision and uterine incision to delivery intervals and previous use of sedative drugs. All these factors have been the subject of extensive investigation and even meta‐analysis [8, 9], but the effects of generic methods of anaesthesia (spinal, epidural and general) on neonatal acid‐base balance, although often studied [5–7, 10–39], have not hitherto been the subject of systematic review. Umbilical artery (UA) acid‐base studies provide the best measure of efficacy of intrapartum intervention [40].…”

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confidence: 99%

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Anaesthesia for Caesarean section and neonatal acid‐base status: a meta‐analysis*

2005

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SummarySpinal anaesthesia is generally preferred for Caesarean section. Its superiority for the baby is often assumed. Umbilical artery acid-base status provides a valid index of fetal welfare. Twenty-seven studies reporting neonatal acid-base data with different types of anaesthesia were used to compare umbilical artery or vein pH and base deficit, using random-effect meta-analysis. Cord pH was significantly lower with spinal than with both general (difference: )0.015; 95% CI )0.029 to )0.001; 13 studies, 1272 subjects) and epidural anaesthesia (difference )0.013; 95% CI )0.024 to )0.002; 11 studies, 828 subjects). Larger doses of ephedrine contributed to the latter effect (p = 0.023). Sixteen studies reported a base deficit, which was significantly higher for spinal than for general (difference 1.109; 95% CI 0.434-1.784 mEq.l )1 ; seven studies, 695 subject) and epidural anaesthesia (difference 0.910; 95% CI 0.222-1.598 mEq.l ; seven studies, 497 subjects). Spinal anaesthesia cannot be considered safer than epidural or general anaesthesia for the fetus. In labour, regional analgesia has a more favourable effect on the newborn than systemic analgesia [1][2][3], a fact that tends to be neglected by consumers and carers alike. By contrast, it is widely accepted that regional anaesthesia for Caesarean section is preferable to general anaesthesia. Spinal anaesthesia is commonly considered both more practical and safer than other techniques for the mother, and is therefore widely used [4]. It is often assumed, similarly, that spinal anaesthesia for Caesarean section must be better for the baby than general or epidural anaesthesia. There are several reasons for this assumption.• General anaesthesia was shown in the 1970s to depress the Apgar score, although this is reversible and rarely significant by 5 min [5,6].• Maternal hypotension, which is believed to be detrimental to fetal wellbeing, can be minimised by appropriate vasopressor control. Cardiac output, however, is more likely to be impaired by spinal than by epidural anaesthesia [7], is rarely measured and may not be so easily corrected.• The doses of drugs required to induce spinal anaesthesia are small and are therefore unlikely to produce systemic effects in the baby. With the brief duration of anaesthesia before delivery of the baby, however, pharmacological fetal depression is likely to be less important than that following prolonged maternal administration of depressant drugs, as may occur during labour. It must be borne in mind, moreover, that drugs may affect the baby in two ways: firstly via a direct effect, resulting from placental drug transfer, which is transient even when general anaesthesia is used for Caesarean section, and clearly unimportant with spinal anaesthesia; and secondly, through an indirect effect resulting from maternal physiological or biochemical changes, which Anaesthesia, 2005, 60 , pages 636-653 .........................................................................................................................................

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

Anaesthesia for Caesarean section and neonatal acid‐base status: a meta‐analysis*

2005

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“…In conclusion, despite the general belief that spinal anaesthesia results in more intensive analgesia for caesarean section, visceral pain continues to be a problem when either isobaric (9) or hyperbaric bupivacaine (0.5°/0) is used.…”

Section: Discussionmentioning

confidence: 96%

Visceral Pain During Caesarean Section Under Spinal and Epidural Anaesthesia With Bupivacaine

Alahuhta¹,

Kangas-Saarela²,

Hollmén³

et al. 1990

Obstetric Anesthesia Digest

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In a randomized study, the incidence of visceral pain was evaluated in 46 patients undergoing elective caesarean section under spinal or epidural anaesthesia with 0.5% bupivacaine. If the patient experienced pain during the operation, a standard visual analogue scale ranging from 0 to 10 was used to assess the degree of pain. Visceral pain occurred in 12/23 patients in the spinal group and in 13/23 patients in the epidural group. In neither group was a correlation found between the cephalad level of analgesia or the intensity of cutaneous analgesia in the sacral region, and the presence of visceral pain.

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“…However, visceral pain during caesarean section often complicates the use of regional anaesthesia. The incidence of visceral pain during caesarean section seems to be similar during both epidural and spinal anaesthesia when plain or hyperbaric 0.5% bupivacaine is used (64,65). An increase in inferior vena cava pressure causes a decreased requirement for anaesthetic agent for the induction of spinal anaesthesia.…”

Section: Bupivacaine Spinal Anaesthesia I N Lower Abdominal Surgerymentioning

confidence: 99%

Bupivacaine spinal anaesthesia

Tuominen

1991

Acta Anaesthesiol Scand

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Subarachnoid Versus Epidural Bupivacaine 0.5% for Caesarean Section

Cited by 5 publications

References 2 publications

Anaesthesia for Caesarean section and neonatal acid‐base status: a meta‐analysis*

Anaesthesia for Caesarean section and neonatal acid‐base status: a meta‐analysis*

Visceral Pain During Caesarean Section Under Spinal and Epidural Anaesthesia With Bupivacaine

Bupivacaine spinal anaesthesia

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