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A randomized trial of maximum cephalad sensory blockade with single-shot spinal compared with combined spinal-epidural techniques for cesarean delivery.
Anesth Analg 2009; 108(1):240-5A&A

Abstract

BACKGROUND

Previous studies have shown more extensive cephalad sensory blockade in women receiving combined spinal-epidural (CSE) anesthesia compared with single-shot spinal (SSS) anesthesia for elective cesarean delivery. It has been postulated that introduction of the epidural needle during CSE disturbs the negative pressure in the epidural space, resulting in relatively greater cerebrospinal fluid (CSF) pressure and increased spread of intrathecal local anesthetic. We tested the hypothesis that CSE results in more extensive cephalad sensory blockade than SSS anesthesia and that loss-of-resistance during initiation of CSE anesthesia increases CSF pressure compared with SSS.

METHODS

Thirty parturients scheduled for elective cesarean delivery were enrolled in this randomized, double-blind study. Patients received either SSS or CSE anesthesia with equal doses of intrathecal anesthetic (hyperbaric bupivacaine 12 mg, fentanyl 10 microg and morphine 200 microg). Before the intrathecal injection, the CSF pressure was measured with a fiberoptic pressure sensor. Maximum cephalad sensory blockade to pinprick, cold and touch was measured. The total dose of phenylephrine required to maintain baseline arterial blood pressure was also recorded.

RESULTS

There were no significant differences in the median (interquartile range) pinprick sensory block height [T4 (T4-2) vs T3 (T4-1)] or CSF pressures [6 (4-12) vs 9 (8-12) mm Hg] between the SSS and CSE groups. There were no significant correlations between CSF pressure and block height or total dose of phenylephrine.

CONCLUSION

The SSS and CSE techniques inserted in the lateral decubitus position resulted in similar extent of sensory blockade and CSF pressure. These findings suggest that altering the intrathecal dose is not necessary and that any difference in intrathecal pressure associated with initial placement of an epidural needle in the epidural space during CSE anesthesia is clinically inconsequential.

Authors+Show Affiliations

Department of Anesthesia, Stanford University School of Medicine, Stanford, California 94305, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19095857

Citation

Horstman, Damian J., et al. "A Randomized Trial of Maximum Cephalad Sensory Blockade With Single-shot Spinal Compared With Combined Spinal-epidural Techniques for Cesarean Delivery." Anesthesia and Analgesia, vol. 108, no. 1, 2009, pp. 240-5.
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;108(1):240-5.
Horstman, D. J., Riley, E. T., & Carvalho, B. (2009). A randomized trial of maximum cephalad sensory blockade with single-shot spinal compared with combined spinal-epidural techniques for cesarean delivery. Anesthesia and Analgesia, 108(1), pp. 240-5. doi:10.1213/ane.0b013e31818e0fa6.
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;108(1):240-5. PubMed PMID: 19095857.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomized trial of maximum cephalad sensory blockade with single-shot spinal compared with combined spinal-epidural techniques for cesarean delivery. AU - Horstman,Damian J, AU - Riley,Edward T, AU - Carvalho,Brendan, PY - 2008/12/20/entrez PY - 2008/12/20/pubmed PY - 2009/1/22/medline SP - 240 EP - 5 JF - Anesthesia and analgesia JO - Anesth. Analg. VL - 108 IS - 1 N2 - BACKGROUND: Previous studies have shown more extensive cephalad sensory blockade in women receiving combined spinal-epidural (CSE) anesthesia compared with single-shot spinal (SSS) anesthesia for elective cesarean delivery. It has been postulated that introduction of the epidural needle during CSE disturbs the negative pressure in the epidural space, resulting in relatively greater cerebrospinal fluid (CSF) pressure and increased spread of intrathecal local anesthetic. We tested the hypothesis that CSE results in more extensive cephalad sensory blockade than SSS anesthesia and that loss-of-resistance during initiation of CSE anesthesia increases CSF pressure compared with SSS. METHODS: Thirty parturients scheduled for elective cesarean delivery were enrolled in this randomized, double-blind study. Patients received either SSS or CSE anesthesia with equal doses of intrathecal anesthetic (hyperbaric bupivacaine 12 mg, fentanyl 10 microg and morphine 200 microg). Before the intrathecal injection, the CSF pressure was measured with a fiberoptic pressure sensor. Maximum cephalad sensory blockade to pinprick, cold and touch was measured. The total dose of phenylephrine required to maintain baseline arterial blood pressure was also recorded. RESULTS: There were no significant differences in the median (interquartile range) pinprick sensory block height [T4 (T4-2) vs T3 (T4-1)] or CSF pressures [6 (4-12) vs 9 (8-12) mm Hg] between the SSS and CSE groups. There were no significant correlations between CSF pressure and block height or total dose of phenylephrine. CONCLUSION: The SSS and CSE techniques inserted in the lateral decubitus position resulted in similar extent of sensory blockade and CSF pressure. These findings suggest that altering the intrathecal dose is not necessary and that any difference in intrathecal pressure associated with initial placement of an epidural needle in the epidural space during CSE anesthesia is clinically inconsequential. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/19095857/A_randomized_trial_of_maximum_cephalad_sensory_blockade_with_single_shot_spinal_compared_with_combined_spinal_epidural_techniques_for_cesarean_delivery_ L2 - http://dx.doi.org/10.1213/ane.0b013e31818e0fa6 DB - PRIME DP - Unbound Medicine ER -