SEQUENTIAL COMBINED SPINAL EPIDURAL BLOCK VERSUS SPINAL-BLOCK FOR CESAREAN-SECTION - EFFECTS ON MATERNAL HYPOTENSION AND NEUROBEHAVIORAL FUNCTION OF THE NEWBORN

Sequential combined spinal-epidural (CSE) block was compared with spinal block for elective cesarean section. The quality of surgical analgesia and the effect on maternal blood pressure and neonatal neurobehavioral function were evaluated. Forty-two healthy parturients were randomly divided into a spinal (n = 21) and a sequential CSE (n = 21) group. A T4 sensory block was targeted. In the spinal group, 0.5% hyperbaric bupivacaine, 2.5 mL, was injected into the subarachnoid space through a 26-gauge Quincke needle. In the sequential CSE group, 1.5 mt of 0.5% hyperbaric bupivacaine was injected into the subarachnoid space through a long 26-gauge Quincke needle, which was introduced through an 18-gauge Tuohy needle. An epidural catheter was then inserted. if the block in the sequential CSE group did not reach the T4 level in 15 min, it was extended by fractionated doses of 0.5% bupivacaine administered through the epidural catheter. Ephedrine, 10 mg intravenously (IV), was given to treat hypotension (20% decrease from baseline value and/or systolic blood pressure below 100 mm Hg). The time intervals from induction of block to start of surgery and to delivery were shorter in the spinal group (P < 0.01). Cephalad spread of block (pinprick) 15 min after induction was T4 [T2-T7] (median [range]) in the spinal group and T7 [T2-L1] in the sequential CSE group (P < 0.05). All patients in the sequential CSE group needed epidural bupivacaine, 53.8 +/- 6.5 mg (mean +/- SEM). The surgical analgesia was good or excellent in both groups before delivery. After delivery, patients in both groups needed a similar amount of supplementary fentanyl and/or dixyrazine IV. Hypotension occurred in 62% of patients in both groups but developed earlier in the spinal group (P < 0.05). Apgar scores, cord blood gases, and neurobehavioral evaluation did not indicate any differences between the two regional anesthesia techniques in their effect on the neonate. No postdural puncture headache was noted. In conclusion, both spinal and sequential CSE block provide good surgical analgesia for cesarean section. Maternal hypotension is a risk with both techniques, but it occurs earlier with spinal block. There is no difference in neonatal outcome, provided that maternal blood pressure is cautiously monitored and hypotension promptly treated.