Randomised controlled trial of combined spinal epidural vs. spinal anaesthesia for elective caesarean section: vasopressor requirements and cardiovascular changes.
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.
Macfarlane
Alan J R
AJ
Department of Anaesthesia, Princess Royal Maternity Hospital, Glasgow, UK. a_m_macfarlane@hotmail.com
Pryn
Artur
A
Litchfield
Kerry N
KN
Bryden
Fiona
F
Young
Steven
S
Weir
Christopher
C
McGrady
Elizabeth M
EM
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*
D014662:Vasoconstrictor Agents; D004809:Ephedrine