Spinal Versus Epidural Anesthesia for Cesarean Delivery in Severe Preeclampsia: A Prospective Randomized, Multicenter Study

Abstract

Epidural anesthesia currently is the preferred method for cesarean delivery in women with severe preeclampsia (defined in this study as a systolic arterial blood pressure [SAP] of 160 mm Hg or higher or a diastolic pressure [DAP] of at least 100 mm Hg in addition to proteinuria of 100 mg/dL or more). Although spinal anesthesia can be instituted more rapidly, has fewer complications, and is more cost-effective, there is concern that rapid and profound hypotension might further compromise the newborn infant. In this prospective, randomized, multicenter study, 47 women not in labor received epidural anesthesia with 18 to 23 mL of 2% lidocaine and 1:400,000 epinephrine followed by 3 mg of morphine after delivery. Another 53 nonlaboring women with severe preeclampsia received 2.2 mL of 0.5% hyperbaric bupivacaine plus 0.2 mg of morphine for spinal anesthesia. The 2 groups were demographically similar and comparable with regard to the volume of intravenous fluid given, treatment with magnesium sulfate or hydralazine, and estimated blood loss. Anesthesia lasted longer in the epidural group despite similar surgical duration times. Median sensory blocked levels were comparable in the epidural and spinal groups. The mean lowest levels of SAP, DAP, and mean arterial pressure (MAP) from induction to delivery were consistently lower in the spinal group. Mean differences were 14, 9, and 10 mm Hg, respectively. After delivery, the 2 groups had similar mean lowest arterial pressures. Significant hypotension, a SAP of 100 mm Hg or less, was approximately twice as frequent in the spinal group, but significant hypotension lasted no longer than 1 minute in both groups. Women given spinal anesthesia received more ephedrine, but hypotension was easily treated. In neither of the premature infants with an adverse outcome was the mother hypotensive. Birth weights, Apgar scores, and the need for admission to a neonatal intensive care unit all were similar in the spinal and epidural groups. These findings support the use of spinal anesthesia for cesarean delivery in women with severe preeclampsia.