title: Randomised controlled trial of combined spinal epidural vs. spinal anaesthesia for elective caesarean section: vasopressor requirements and cardiovascular changes.
abstract: OBJECTIVE
  Combined spinal and epidural anaesthesia (CSEA) has previously been shown to result in a higher sensory block than equivalent single shot spinal anaesthesia (SSSA). In nonpregnant patients, hypotension was also more pronounced in the CSEA group. The aim of this randomized trial was to compare the haemodynamic stabilities of CSEA and SSSA during elective caesarean section when the same dose of anaesthetic was administered. This was studied directly by measuring the noninvasive arterial blood pressure (BP) and indirectly by the amount of ephedrine required to maintain baseline BP. Systemic vascular resistance index (SVRI) and cardiac index (CI) were also measured using thoracic impedance cardiography.
  
  
  METHODS
  Seventy women received hyperbaric bupivacaine (12.5 mg) and diamorphine (0.3 mg) intrathecally via either CSEA or SSSA. Noninvasive arterial BP, CI and SVRI were measured every 2 min. The total ephedrine used was calculated.
  
  
  RESULTS
  There were no significant differences between the groups in ephedrine requirements (P = 0.38), intraoperative mean arterial pressure (P = 0.77), CI (P = 0.17) or SVRI (P = 0.10).
  
  
  CONCLUSIONS
  CSEA placement appears to offer no haemodynamic benefits compared with SSSA when the same dose of local anaesthetic is administered.
authors.affiliation: Department of Anaesthesia, Princess Royal Maternity Hospital, Glasgow, UK. a_m_macfarlane@hotmail.com
authors.forename: Alan J R
authors.initials: AJ
authors.lastname: Macfarlane
authors.forename: Artur
authors.initials: A
authors.lastname: Pryn
authors.forename: Kerry N
authors.initials: KN
authors.lastname: Litchfield
authors.forename: Fiona
authors.initials: F
authors.lastname: Bryden
authors.forename: Steven
authors.initials: S
authors.lastname: Young
authors.forename: Christopher
authors.initials: C
authors.lastname: Weir
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McGrady
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D002319:Cardiovascular System / Q000187:drug effects*; D002585:Cesarean Section; D004809:Ephedrine / Q000494:pharmacology; D005260:Female; D006801:Humans; D014662:Vasoconstrictor Agents / Q000494:pharmacology*
chemical_list: D014662:Vasoconstrictor Agents; D004809:Ephedrine