Regional anaesthesia for caesarean section in severe preeclampsia: spinal anaesthesia is the preferred choice

Standard textbooks advocate epidural rather than spinal anaesthesia for cae sarean section in severe preeclampsia. The basis for this recommendation is the theoretical risk of severe hypotension but no published scientific stu dies have been identified to support this assertion. We therefore designed a prospective study to compare spinal versus epidural anaesthesia in severe ly pre-eclamptic patients requiring hypotensive therapy. Following ethics c ommittee approval, 28 women with preeclampsia requiring hypotensive medicat ion who were scheduled for urgent (not emergency) or elective caesarean sec tion consented to receive epidural or spinal anaesthesia by random assignme nt. Seven patients were excluded due to protocol violations. Four of these were in the epidural group of which two were excluded due to inadequate ana lgesia. No spinal patient was excluded because of inadequate analgesia. Mea n ephedrine dosage was 5.2 mg (range 0-24 mg) in the spinal group and 6.3 m g (range 0-27 mg) in the epidural group. Six of the 11 patients in the spin al group required no ephedrine as did five of 10 in the epidural group. One patient in the spinal group suffered from mild intraoperative pain. By con trast in the epidural group three patients had mild pain and four others ha d pain severe enough to warrant intraoperative analgesia. There were no dif ferences in neonatal outcomes. These findings support recent studies sugges ting the safety and efficacy of spinal anaesthesia in this group of patient s.