Efficacy comparison of combined spinal epidural anesthesia and epidural anesthesia in the scarred uterus during cesarean section

Abstract

Objective To compare the anesthetic effect and safety of combined spinal epidural anesthesia (CSEA) and epidural anesthesia (EA) in the scarred uterus during cesarean section.Methods One hundred and twenty cases of the scar uterine pregnant woman aged 23-42,were randomly divided into two groups,EA group (60 cases)and CSEA group(60 cases).In each group,patient were given EA or CSEA before cesarean section,and the ECG,BP,HR,RR and SpO2 were monitored.The pain disappear plane by acupuncture was determined,and the sensory block onset time (when the sensory block parts have fever or numbness after the drug delivery time) was recorded.The lower limb motor block effects were indentified by the improved Browage grading,the Apgar scores of the newborns were recorded and the adverse reactions such as headache,vomiting after anesthesia were observed.Results The sensory block onset time of EA group was significantly slower than that of CSEA group (P ＜ 0.05),the pain disappear plane of CSEA group was higher than that of EA group (P ＜ 0.05),the limb motor block effect of EA group was much lower than that of CSEA group (P ＜ 0.01).Because of insufficient anesthesia,7 cases in EA group could not tolerate the surgery,and had to add assisted local infiltration anesthesia or intravenous analgesics to complete the operation,2 of them changed to general anesthesia.None of the patients in CSEA group had assisted intravenous analgesics or changed to general anesthesia,the anesthetic effect was significantly better than EA group (P ＜0.01).There were no cases of headache or neurological complications occurred in CSEA group after anesthesia.The Apgar scores of the newborns when the baby was delivered and 1 min after birth in CSEA group were significantly better than those in EA group (P ＜ 0.05),and there was no significant difference in the Apgar scores 5 min or 10 min after birth between the two groups (P ＞ 0.05).Conclusions By small doses of anesthetics,strictly controling the speed of injection and anesthesia plane,CSEA has a great superiority compare to EA when apply to the scarred uterus during cesarean section,CSEA is safe and effective,and can be used as the first choice for anesthesia in the scarred uterus during cesarean section operation. Key words: Combined spinal epidural anesthesia; Epidural anesthesia; Scarred uterus; Cesarean section