SEQUENTIAL COMBINED SPINAL EPIDURAL BLOCK VERSUS SPINAL-BLOCK FOR CESAREAN-SECTION - EFFECTS ON MATERNAL HYPOTENSION AND NEUROBEHAVIORAL FUNCTION OF THE NEWBORN

Sequential combined spinal-epidural (CSE) block was compared with spin al block for elective cesarean section. The quality of surgical analge sia and the effect on maternal blood pressure and neonatal neurobehavi oral function were evaluated. Forty-two healthy parturients were rando mly divided into a spinal (n = 21) and a sequential CSE (n = 21) group . A T4 sensory block was targeted. In the spinal group, 0.5% hyperbari c bupivacaine, 2.5 mL, was injected into the subarachnoid space throug h a 26-gauge Quincke needle. In the sequential CSE group, 1.5 mt of 0. 5% hyperbaric bupivacaine was injected into the subarachnoid space thr ough a long 26-gauge Quincke needle, which was introduced through an 1 8-gauge Tuohy needle. An epidural catheter was then inserted. if the b lock in the sequential CSE group did not reach the T4 level in 15 min, it was extended by fractionated doses of 0.5% bupivacaine administere d through the epidural catheter. Ephedrine, 10 mg intravenously (IV), was given to treat hypotension (20% decrease from baseline value and/o r systolic blood pressure below 100 mm Hg). The time intervals from in duction of block to start of surgery and to delivery were shorter in t he spinal group (P < 0.01). Cephalad spread of block (pinprick) 15 min after induction was T4 [T2-T7] (median [range]) in the spinal group a nd T7 [T2-L1] in the sequential CSE group (P < 0.05). All patients in the sequential CSE group needed epidural bupivacaine, 53.8 +/- 6.5 mg (mean +/- SEM). The surgical analgesia was good or excellent in both g roups before delivery. After delivery, patients in both groups needed a similar amount of supplementary fentanyl and/or dixyrazine IV. Hypot ension occurred in 62% of patients in both groups but developed earlie r in the spinal group (P < 0.05). Apgar scores, cord blood gases, and neurobehavioral evaluation did not indicate any differences between th e two regional anesthesia techniques in their effect on the neonate. N o postdural puncture headache was noted. In conclusion, both spinal an d sequential CSE block provide good surgical analgesia for cesarean se ction. Maternal hypotension is a risk with both techniques, but it occ urs earlier with spinal block. There is no difference in neonatal outc ome, provided that maternal blood pressure is cautiously monitored and hypotension promptly treated.