CSE VS. AUGMENTED EPIDURAL-ANESTHESIA FOR CESAREAN-SECTION - SPINAL-ANESTHESIA AND EPIDURAL-ANESTHESIA WITH BUPIVACAINE 0,5-PERCENT ISOBAR REQUIRE AUGMENTATION

Incomplete anaesthesia is a major clinical problem both in single spin al and in single epidural anaesthesia. The clinical efficacy of epidur al anaesthesia with augmentation (aEA) and combined epidural and spina l anesthesia (CSE) for cesarean section was investigated in a prospect ive randomized study on 45 patients. Methods: Anaesthesia extending up to Th5 was aimed for. Depending on the patient's height, epidural ana esthesia was administered with a dose of 18-22 mi 0.5% bupivacaine and spinal anaesthesia with a dose of 11-15 mg 0.5% bupivacaine. Augmenta tion was carried out in all cases in epidural anaesthesia, initially w ith 7.5 mi 1% Lidocaine with epinephrine 1:400000, raised by 1.5 mi pe r missing segment. The epidural reinjection in CSE was carried out as necessary with 9.5-15 mi 1% lidocaine with epinephrine, depending on t he height and difference from the segment Th5. Results: The extension of anaesthesia achieved in epidural anaesthesia after an initial dose of 101.8 mg bupivacaine and augmenting dose of 99 mg lidocaine reached the segment Th5. The primary spinal anaesthesia dose up to 15 mg corr esponding to height led to a segmental extension to a maximum of Th3 u nder CSE. Augmentation was necessary in 13 patients; in 5 cases becaus e of inadequate extent of anaesthesia and 8 cases because of pain resu lting from premature reversion. The augmenting dose required was 13.9 mi. Readiness for operation was attained after 19.8 min (aEA) and afte r 10.5 min (CSE). No patient required analgesics before delivery. The additional analgesic requirement during operation was 63.6% (aEA) and 39.1% (CSE). Taking into account pain in the area of surgery, the requ irement of analgesics was 50% (aEA) vs. 17.4% (CSE). Antiemetics were required in 18.2 (a EA) and in 65.2% (CSE). The systolic blood pressur e fell by 17.7% (aEA) and in 30.3% (CSE) The minimum systolic pressure was observed after 13.4 min in aEA, and after 9.5 min in CSE. The APG AR score and the umbilical pH did not show any differences. General an aesthesia was not required in any case. A single epidural anaesthesia or a single spinal anaesthesia with isobaric 0.5% bupivacaine are not reliable as the sole, nonaugmentable anaesthesia. Isobaric spinal anae sthesia primarily achieves an appropriate extent of anaesthesia, but o ften a Iso requires supplementary epidural reinjection for complete an algesia. An augmentation proves to be appropriate primarily with 0.5% bupivacaine in aEA. The operation can be commenced earlier with CSE.