SPINAL VERSUS EPIDURAL-ANESTHESIA FOR CESAREAN-SECTION - A COMPARISONOF TIME EFFICIENCY, COSTS, CHARGES, AND COMPLICATIONS

Spinal anesthesia recently has gained popularity for elective cesarean section. Our anesthesia service changed from epidural to spinal anest hesia for elective cesarean section in 1991. To evaluate the significa nce of this change in terms of time management, costs, charges, and co mplication rates, we retrospectively reviewed the charts of patients w ho had received epidural (n = 47) or spinal (n = 47) anesthesia for no nemergent cesarean section. Patients who received epidural anesthesia had significantly longer total operating room (OR) times than those wh o received spinal anesthesia (101 +/- 20 vs 83 +/- 16 min, [mean +/- S D] P < 0.001); this was caused by longer times spent in the OR until s urgical incision (46 +/- 11 vs 29 +/- 6 min, P < 0.001). Length of tim e spent in the postanesthesia recovery unit was similar in both groups . Supplemental intraoperative intravenous (IV) analgesics and anxiolyt ics were required more often in the epidural group (38%) than in the s pinal group (17%) (P < 0.05). Complications were noted in six patients with epidural anesthesia and none with spinal anesthesia (P < 0.05). Average per-patient charges were more for the epidural group than for the spinal group. Although direct cost differences between the groups were negligible, there were more substantial indirect costs difference s. We conclude that spinal block may provide better and more cost effe ctive anesthesia for uncomplicated, elective cesarean sections.