Comparison of incremental spinal anesthesia using a 32-gauge catheter with extradural anaesthesia for elective caesarean section.
Forty-three mothers who had requested regional anaesthesia for elective Caesarean section were allocated randomly to receive either extradural anaesthesia with pH-adjusted 2% lignocaine with 1/200,000 adrenaline, or incremental spinal anaesthesia using a 32-gauge catheter with 0.5% plain bupivacaine. Increments of lignocaine or bupivacaine were given with the aim of achieving a block from T4 to S5. The spinal catheter was quicker to place (median 3 min, range 1-45 min, compared with median 10 min, range 1.5-50 min) and spinal anaesthesia was quicker to establish (median 20 min, range 10-46 min compared with median 48 min, range 15-59 min) compared with the extradural technique. The maximum height of the spinal block was significantly higher (median T3-4, range T5-T3) than the extradural group (median T5, range T6-T3). The total dose of intrathecal 0.5% bupivacaine was unpredictable, with a mean dose of 2.7 ml and a range between 1.5 ml and 7.4 ml. Haemodynamic stability and the quality of the block were similar between the groups. There were two mild spinal-headaches in the spinal group. All the spinal catheters were removed intact.
Kestin
I G
IG
Department of Anaesthesia, Southmead Hospital, Westbury-on-Trym, Bristol.
Madden
A P
AP
Mulvein
J T
JT
Goodman
N W
NW
D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal / Q000295:instrumentation / Q000379:methods*; D002045:Bupivacaine; D002404:Catheterization / Q000295:instrumentation*; D002585:Cesarean Section; D005260:Female; D006801:Humans; D008012:Lidocaine; D011247:Pregnancy; D011897:Random Allocation; D016037:Single-Blind Method
D008012:Lidocaine; D002045:Bupivacaine