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Comparison of the maternal and neonatal effects of epidural block and of combined spinal-epidural block for Cesarean section.
Eur J Obstet Gynecol Reprod Biol. 2005 Jul 01; 121(1):18-23.EJ

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.

Authors+Show Affiliations

Department of Anesthesiology and Reanimation, Ege University Faculty of Medicine, Izmir, Turkey.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

15989982

Citation

Karaman, Semra, et al. "Comparison of the Maternal and Neonatal Effects of Epidural Block and of Combined Spinal-epidural Block for Cesarean Section." European Journal of Obstetrics, Gynecology, and Reproductive Biology, vol. 121, no. 1, 2005, pp. 18-23.
Karaman S, Akercan F, Akarsu T, et al. Comparison of the maternal and neonatal effects of epidural block and of combined spinal-epidural block for Cesarean section. Eur J Obstet Gynecol Reprod Biol. 2005;121(1):18-23.
Karaman, S., Akercan, F., Akarsu, T., Firat, V., Ozcan, O., & Karadadas, N. (2005). Comparison of the maternal and neonatal effects of epidural block and of combined spinal-epidural block for Cesarean section. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 121(1), 18-23.
Karaman S, et al. Comparison of the Maternal and Neonatal Effects of Epidural Block and of Combined Spinal-epidural Block for Cesarean Section. Eur J Obstet Gynecol Reprod Biol. 2005 Jul 1;121(1):18-23. PubMed PMID: 15989982.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of the maternal and neonatal effects of epidural block and of combined spinal-epidural block for Cesarean section. AU - Karaman,Semra, AU - Akercan,Fuat, AU - Akarsu,Tülin, AU - Firat,Vicdan, AU - Ozcan,Ozge, AU - Karadadas,Nedim, PY - 2004/03/31/received PY - 2004/07/01/revised PY - 2004/08/05/accepted PY - 2005/7/2/pubmed PY - 2005/11/8/medline PY - 2005/7/2/entrez SP - 18 EP - 23 JF - European journal of obstetrics, gynecology, and reproductive biology JO - Eur J Obstet Gynecol Reprod Biol VL - 121 IS - 1 N2 - 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. SN - 0301-2115 UR - https://www.unboundmedicine.com/medline/citation/15989982/Comparison_of_the_maternal_and_neonatal_effects_of_epidural_block_and_of_combined_spinal_epidural_block_for_Cesarean_section_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0301-2115(04)00537-8 DB - PRIME DP - Unbound Medicine ER -