Comparison of the maternal and neonatal effects of combined spinal-epidural block and spinal block for cesarean section

Objectives: Combined spinal-epidural block (CSEB) has gained increasing interest as it combines the reliability of a spinal block (SB) and the flexibility of an epidural block in cesarean section. We investigated the maternal and fetal effect of CSEB against SB in cesarean operation. Methods: Forty healthy, term pregnant women were randomized into two groups. Patients in the CSEB and SB groups were given 1.5 ml and 2.5 ml of 0.5% hyperbaric bupivacaine intrathecally, respectively. If sensorial block did not reach T4 within 10 min, supplemental bupivacaine was injected epidurally 2 ml per unblocked segment in the CSEB group. The quality and side effects of surgical anesthesia, hemodynamic parameters, Apgar scores, neurological and adaptive capacity score (NACS) and postoperative duration of pain were compared between the two groups. Results: The time for the block to reach the T4 level was significantly lower in the SB group (p<0.05). More patients in the SB group achieved complete motor blockade sooner than in the CSEB group (p<0.05). Mean arterial pressure was lower in the SB group (p<0.05). There were no significant differences between the groups with respect to Apgar scores, cord blood gases, NACS, and adverse effects such as nausea and vomiting. Conclusion: Both SB and CSEB provide good surgical analgesia for cesarean section. Maternal hypotension is a risk with both techniques, but it occurs earlier and is greater with SB. There is no difference in neonatal outcome, provided that maternal blood pressure is cautiously monitored and hypotension promptly treated.