EPIDURAL-ANESTHESIA FOR CESAREAN DELIVERY IN TRIPLE AND QUADRUPLE PREGNANCIES

Background: Mechanical and/or hormonal factors may increase the spread of epidural anaesthesia in pregnancy, and hormonal changes are more p ronounced in high-order pregnancies. However, no previous study has ev aluated the dose requirements and haemodynamic effects of epidural ana esthesia for caesarean delivery in this latter situation. Methods: The anaesthetic requirements to obtain a T4 upper sensory level were rest rospectively compared in triple (n=19) or quadruple (n=2) pregnancies to 31 singleton pregnancies who received epidural anaesthesia for elec tive caesarean delivery using 2% lidocaine with 1/200 000 adrenaline. Results: In high-order pregnancies, the gestational age at delivery wa s lower than in singleton pregnancies (34.9+/-1.9 weeks vs 38.2+/-1.1 weeks; P=0.0001) whereas maternal body weight (76.5+/-8.7 kg vs 73.4+/ -14.8 kg; NS) and lidocaine requirements (428+/-95 mg vs 426+/-98 mg; NS) were similar. Moreover, although the overall incidence of hypotens ion was not different (multiple pregnancy; 65% vs 58% in singletons), ephedrine (5.4+/-5.3 mg vs 10.7+/-13.8 mg; P<0.05) and additional flui d requirements during onset of the block (4.3+/-1.7 mL/kg vs 5.3+/-2.6 mL/kg; P=0.03) were less than in singletons. Conclusion: We found sur prisingly similar anaesthetic requirements for epidural anaesthesia in high-order and singleton pregnancies. Mechanical factors may have pla yed an important rule. Moreover, the need for ephedrine and fluids was less in high-order pregnancies. This could be related to more pronoun ced physiological changes or to different physician attitudes.