title: Comparison of sequential combined spinal-epidural anesthesia and spinal anesthesia for cesarean section.
abstract: OBJECTIVE
  The aim of our study was to prove that by using sequential combined spinal-epidural (CSE) anesthesia it is possible to overcome the limits connected to the use of spinal anesthesia (SA) alone for elective cesarean section.
  
  
  METHODS
  We examined 100 women submitted to cesarean section; SA was administered to 50 patients and sequential CSE technique to the other 50. In every woman before execution of the anesthesia we infused 500 mL of a plasma expander and a previous administration of 5 mg of ephedrine. The CSE was executed at the L1-L2 intervertebral space, administering in spinal anesthesia 5 mg of levobupivacaine with 5 _g of sufentanil, and in peridural anesthesia 10-12 mL of levobupivacaine 0.25% according to the patient's height. The peridural catheter for postoperative analgesia was then positioned. In the group of women submitted only to SA, 7.5-8 mg of levobupivacaine was injected, according to the patient's height, in the L1-L2 intervertebral space, with 5 _g of sufentanil. We considered the following adverse effects: hypotension; bradycardia; vomiting; intraoperative discomfort and motor block.
  
  
  RESULTS
  The results obtained showed that, with a P < or = 0.05, the incidence of motor block (P < 0.001), discomfort (P < 0.001) and hypotension (P = 0.021) in the SA group is greater than in the CSE group. The difference in the incidence of vomiting (P = 0.147) and bradycardia (P = 0.067) between the 2 groups is not statistically significant.
  
  
  CONCLUSIONS
  In our opinion sequential CSE can be considered an important step forward in the regional anesthesia used for elective cesarean section.
authors.affiliation: Unit of Obstetric Anesthesia, Casa di Cura S.Maria, Bari, Italy. abrizzi@libero.it
authors.forename: A
authors.initials: A
authors.lastname: Brizzi
authors.forename: F
authors.initials: F
authors.lastname: Greco
authors.forename: A
authors.initials: A
authors.lastname: Malvasi
authors.forename: A
authors.initials: A
authors.lastname: Valerio
authors.forename: V
authors.initials: V
authors.lastname: Martino
mesh_terms: D000767:Anesthesia, Epidural / Q000379:methods*; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal / Q000379:methods*; D002585:Cesarean Section; D005260:Female; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies