Comparison of combined spinal epidural anesthesia and epidural anesthesia for cesarean section

Background: Epidural anesthesia (EA) is popular for cesarean section, but h as some drawbacks such as incomplete block, inadequate muscle relaxation an d delayed onset. Combined spinal epidural anesthesia (CSEA) has gained incr easing interest as it combines the reliability of a spinal block and the fl exibility of an epidural block. We investigated the efficacy of CSEA that c ombines the main spinal and the supporting epidural anesthesia, comparing w ith pH-adjusted EA, for cesarean section. Methods: Sixty-four pregnant women at full term were divided into two group s. Patients in the CSEA group (n=32) were given 1.5-1.6 ml of 0.5% hyperbar ic bupivacaine intrathecally, followed by 10 ml of 0.25% plain bupivacaine through the epidural catheter 10 min later. Patients in the EA group (n=32) received 20-25 mi of 2% lidocaine which was already mixed with 0.1 mi of 0 .1% epinephrine, 100 g of fentanyl and 1.5 mi of 8.4% sodium bicarbonate. T he quality and side effects of surgical anesthesia, neonatal state, and pos toperative course were compared between the two groups. Results: In the EA group, 22% (7 cases) complained of intraoperative pain b ut none in the CSEA group (P=0.011). Muscle relaxation and motor black were much better in the CSEA group (P<0.001 and P=0.011 each). Significantly mo re women in the EA group had shivering (P=0.001). They also had more nausea and vomiting but the differences were not significant. Not only the time t o T4 block (9.7 vs, 18.3 min, mean, P<0.001) but also the stay in the posta nesthesia care unit, recovery of sensory and motor block and start of posto perative pain were all significantly shorter in the CSEA group. No one in e ither group had postdural puncture headache (PDPH). Conclusion: We can conclude that, when combining the main spinal and the su pporting epidural anesthesia, CSEA has greater efficacy and fewer side effe cts than the pH-adjusted EA in cesarean sections.