THE HEMODYNAMIC EFFECTS OF COMBINED SPINAL-EPIDURAL VERSUS SPINAL ANESTHESIA IN CESAREAN SECTION

Authors

  • Mohanned Wajeeh Saeed Zerary Sulaimani Teaching Hospital, Ministry of Health, Kurdistan Region, Iraq.
  • Van Nasih Mohammed Royal Hospital, Ministry of Health, Sulaimani, Kurdistan Region, Iraq.
  • Amir Murad Khudadad Boujan College of the Medicine, University of Sulaimani, Kurdistan Region, Iraq.

DOI:

https://doi.org/10.17656/jsmc.10378

Keywords:

Combined spinal-epidural, Cesarean section, Hypotension, Bradycardia

Abstract

Background 

Hypotension and bradycardia are the main problems in parturients anesthetized with spinal anesthesia for cesarean section. It is a common cause of maternal and fetal morbidity and mortality; the combined spinal-epidural anesthesia technique is a new way to solve the problem.

Objectives 

The hemodynamic effects of combined spinal-epidural anesthesia will be compared to spinal anesthesia alone in cesarean section.

Patients and Methods

After the approval of the local ethical committee and taking patients’ consent, 100 parturients at Sulaimani Maternity Hospital scheduled for cesarean section were involved in the study. They were divided into two groups; group S (n_50) received (3ml) of bupivacaine in a single spinal shot technique. Group CSE (n_50) received (2 ml) of the same drug with the insertion of an epidural catheter to give additional doses later in a combined spinal-epidural technique. Blood pressure and pulse rate were measured regularly at 5 minutes intervals throughout the operation. After shifting the patient to the ward, they continued the measurement postoperatively for one hour with 15 minutes intervals. 

Results

Hypotension was more common in group S in 42 cases versus 7 in the CSE group. It was significant (P=0.012). Also, bradycardia occurred in 15 cases in the S group while it was only in 6 cases in the CSE group which were significant (P = 0.008).

Conclusion

The maternal hemodynamic changes were less significant with the combined Spinal-Epidural technique compared to routine spinal anesthesia of cesarean section.

References

Raj PP.Conduction Blocks. In:Benzon HT., Erdine S, Heavner JE.Niv David, (Eds). Text Book of Regional Anesthesia. 1st edition vol1. Philadelphia: Churchill Livingstone; 2003. p 348 – 50.

Larson M. History of Anesthetic Practice. In: Miller RD, Ericson LI, Fleisher LA, Wiener-Kronish JA , Young WL (Eds). Miller’s Anesthesia. 7th Edition vol 1. New York: Churchill Livingstone; 2009. p 30 – 36.

Caton D. The History of Obstetric Anesthesia. In: Chestnut DH. Chestnut’s Obstetric Anesthesia: Principles and Practice., 3rd Edition.Philadelphia: Elsevier Mosby; 2004. P 7 – 9 DOI: https://doi.org/10.1016/B978-0-323-05541-3.00001-6

Segal S. Anesthesia for Cesarean Delivery.In: Datta S, Kodali BS (Eds). Obstetric Anesthesia Handbook. 5th Edition. New York: Springer; 2010, p 181 -184.

Ben-David B, Miller G, Gavriel R, Gurevitch A. Low-dose bupivacaine-fentanyl spinal anesthesia for cesarean delivery. Reg Anesth Pain Med 2000; 25: 235–9. DOI: https://doi.org/10.1097/00115550-200005000-00005

Lyons G, Macdonald R, Miki B. Combined epidural /spinal anesthesia for section. Through the needle or in separate spaces. Anaesthesia 1992; 47: 199- 01. DOI: https://doi.org/10.1111/j.1365-2044.1992.tb02117.x

Ong K, Sashidharan R. Combined spinal–epidural techniques: continuing education in anesthesia critical care and pain. Oxford Journals Medicine BJA. 2007; 7(2): 38-41. DOI: https://doi.org/10.1093/bjaceaccp/mkm003

Beale N, Evans B, Plaat F, Columb MO, Lyons G Stocks GM.Effect of epidural volume extension on dose requirement of intrathecal hyperbaric bupivacaine at Caesarean section. Oxford Journals Medicine BJA. 2005; 95(4): 500-503. DOI: https://doi.org/10.1093/bja/aei200

Horstman DJ, Riley ET, Carvalho B. A Randomized Trial of Maximum cephalad Sensory Blockade with Single-Shot Spinal Compared with Combined Spinal-Epidural Techniques for Cesarean Delivery. Anesth Analg. 2009 Jan; 108 (1): 240-245. DOI: https://doi.org/10.1213/ane.0b013e31818e0fa6

Choi DH; Ahn HJ; Kim JA, Combined low-dose spinal-epidural anesthesia versus single-shot spinal anesthesia for elective cesarean delivery. Int J Obstet Anesth. 2006; 15(1):13-7 DOI: https://doi.org/10.1016/j.ijoa.2005.05.009

Stasiuk Violeta, Victor Cojocaru, Combined spinal-epidural anesthesia for cesarean section, Ph.D. Thesis 2008, State University of Medicine and Pharmacy "Nicolae Testemitanu, Moldova"

Malvasi, A. Tinelli, M. Stark, G. Pontrelli, A. Brizzi, R.G. Wetzel, D. Benhamou, Low-dose sequential combined spinal-epidural anesthesia in elective cesarean section: a preliminary cohort study, Eur Rev Med Pharmacol Sci,2010; 14 (3): 215-221.

Mebazaa MS, Meftah RB, Abbasi M, Mestiri T, Ammar MS. Combined Spinal-Epidural Anesthesia or Single Shot Spinal Anesthesia for Preeclamptic Parturient Undergoing Cesarean Section.American Society of Anesthesiology Annual Meeting;2003; California. Cochrane Central Register of controlled trials;2004;99(3): A1202.

Brizzi A, Greco F, Malvasi A, Valerio A, Martino V, Comparison of sequential combined spinal-epidural anesthesia and spinal anesthesia for cesarean section. Minerva Anestesiol. 2005 Nov; 71(11):701-9.

Ko J,Kim C, Cho H, Choi D. A randomized trial of crystalloid versus colloid solution for preventing hypotension during spinal or low-dose combined spinal-epidural anesthesia for elective cesarean deliveryâ. International Journal of Obstetric Anesthesia .2006 ;16 (1); 8 -12 J. DOI: https://doi.org/10.1016/j.ijoa.2006.07.004

Roofthooft E, Van de Velde M, Low-dose spinal anesthesia for Caesarean section to prevent spinal-induced hypotension. Curr Opin Anaesthesiol. 2008 Jun;21(3):259-62. DOI: https://doi.org/10.1097/ACO.0b013e3282ff5e41

Farida Ithnin, Yvonne Lim, Alex T. Sia, and Cecilia E. Ocampo, Combined Spinal Epidural Causes Higher Level of Block than Equivalent Single-Shot Spinal Anesthesia in Elective Cesarean Patients, Anesth Analg 2006;102:577–80. DOI: https://doi.org/10.1213/01.ane.0000195440.51717.37

Joachim Klasen, Axel Junger, Bernd Hartmann, Matthias Benson, Andreas Jost, Anne Banzhaf, Myron Kwapisz, and Gunter Hempelmann, Differing Incidences of Relevant Hypotension with Combined Spinal-Epidural Anesthesia and Spinal Anesthesia, Anesth Analg 2003;96:1491–5. DOI: https://doi.org/10.1213/01.ANE.0000057601.90930.18

Yvonne Lim, Wendy Teoh, Alex T. Sia, Combined Spinal Epidural Does Not Cause a Higher Sensory Block than Single Shot Spinal Technique for Cesarean Delivery in Laboring Women, International Anesthesia Research Society; 2006 Vol. 103, No. 6:1540–2 DOI: https://doi.org/10.1213/01.ane.0000243392.91765.52

Published

2022-12-21

How to Cite

1.
Zerary M, Mohammed V, Boujan A. THE HEMODYNAMIC EFFECTS OF COMBINED SPINAL-EPIDURAL VERSUS SPINAL ANESTHESIA IN CESAREAN SECTION. JSMC [Internet]. 2022 Dec. 21 [cited 2024 Jun. 19];12(4):345-51. Available from: https://jsmc.univsul.edu.iq/index.php/jsmc/article/view/jsmc-10378

Similar Articles

1-10 of 61

You may also start an advanced similarity search for this article.