Cesarean section in mild preeclamptic patients, spinal versus epidural anesthesia

Abstract EN

Patient.This study was carried out in Assiut University Hospital in the Department Obstetrics and Gynecology, in the period from January 2002 to January 2003.

The study ^ approved by our local institutional ethics committee.

All patients had been informed ah^ the nature of the study and a written or verbal consent was obtainedfrom each one.

F0J parturients with mild pre-eclampsia (systolic blood pressure 140-160mm/Hg diastolic i/oj pressure 90-100mm/Hg) undergoing cesarean section, with no contraindication for regiotJ anesthesia (sepsis.bleeding tendency, severe stenotic valvular heart disease and plated count<100000mm3) were enrolled in the study.

Method: General and obstetric examination as well as obstetric ultrasonography w^j done for all women.

Patients were allocated randomly into two groups; group 1 recent spinal anesthesia, bupivacain 0.5% [(8-12 mg) (2 -2.5ml)] andgroup 11received epidural anesthesia, bupivacain 0.5% [(30-40 mg) (6-8ml)] andlidocaine 2% [(120-160 mg) (d 8ml)].

f Hemodynamic data (systolic, diastolic, mean blood pressure and heart rate) were recorded immediately before induction of anesthesia and every 5 minutes after induction till the endtf the operation..

Neonatal outcome was assessed by Apgar score at 1 minute and 5 minutes; any intra-operative complication was recorded.

Amount of blood loss was subjectively assessed by the obstetrician.

The quality of anesthesia was assessed in the two groups by sensory level determination and Bromage scale for motor block assessment, subjective assessment of the quality of anesthesia was done using VRS scales.

Amount of crystalloid fluid and ephedrine doses were estimated.

Side effects such as hypotension, bradycardia, nausea, and vomiting were recorded.

Results of the study showed that: Blood pressure decreased significantly after induction of regional block at 5, 10 and 15 minutes than the baseline value in the two groups, where it was lower in group I than group II.

Heart rate decreased significantly after induction of regional block than the baseline value in both groups but was within the physiologic range.

Neonatal outcome was favorable in both groups, Apgar score at 1 minute and 5 minutes >8 points.

No recorded intra-operative complications and blood loss was average.

As regards the quality of anesthesia; The motor and sensory bio ckw ere more pronounced in spinal group than epidural group, the patients were more satisfactory and comfortable in spinal than epidural group.

The amounts of crystalloidfluid and ephedrine usedfor prevention and treatment of hypotension were comparable with no significant difference between both groups.

Side effects: There were insignificant difference between the two groups as regards nausea, vomiting, bradycardia hypotension and shivering.

Conclusion: The regional anesthesia (Spinal-epidural) is a sound choice in mild preeclamptic parturient provided that all risk factors (including thrombocytopenia and platelet function defect) are assessed and the patient is stable.

The amount of blood loss is within normal and the neonatal outcome is satisfactory.

Spinal anesthesia is superior to epidural anesthesia, because both techniques have similar haemodynamic changes and neonatal outcome.

However, the spinal anesthesia has many advantages over epidural anesthesia, like easy technique, less time consuming, less cost, intense sensory and motor block and patients