Spinal-epidural Anaesthesia For Caesarean Section Research Articles

Whole-course application of dexmedetomidine as an adjuvant to spinal-epidural anesthesia for cesarean section: A randomized, controlled trial

BackgroundDexmedetomidine is known to prolong the analgesic duration of spinal anesthesia, but it can be challenging to achieve further extension without opioids. Therefore, this study aimed to investigate a novel analgesic strategy using dexmedetomidine as an adjuvant to spinal-epidural anesthesia for elective cesarean surgery. MethodsThe study was a randomized, double-blind, controlled trial conducted at a single center. Sixty parturients who underwent elective cesarean were randomly assigned to either group C or group D. Group D received an intrathecal injection of 12.5 mg ropivacaine and 5 μg dexmedetomidine followed by continuous epidural patient-controlled analgesia (PCA) infusion with a total volume of 100 ml, containing 0.2 % ropivacaine and 0.5 μg/kg dexmedetomidine. Group C received an intrathecal injection of 12.5 mg ropivacaine with an equivalent saline placebo followed by a similar PCA infusion, containing 0.2 % ropivacaine and an equivalent saline placebo. ResultsThe primary outcome was visual analog scale score on movement at 24 h after surgery. The results showed that the rest and motion pain scores in group D were significantly lower than those in group C at 6 h, 12 h, and 24 h after surgery (P < 0.05), with the differences at 24 h were 5.0 (5.0, 5.0)in group D versus 5.0 (5.0, 6.0) in group C (P = 0.04). Additionally, the time to the first PCA in group D was significantly longer than that in group C (P < 0.05), as well as the time of sensory and motor recovery. ConclusionsWhole-course application of dexmedetomidine as an adjuvant to spinal-epidural anesthesia could effectively extend the analgesic duration of ropivacaine to 24 h following elective cesarean surgery.

Effective Dose of Prophylactic Norepinephrine for Preventing Hypotension under Combined Spinal and Epidural Anesthesia during Cesarean Section in Singleton Versus Twin Pregnancies

To determine and compare the 90% effective dose (ED 90) of prophylactic infusion of norepinephrine for preventing hypotension during combined spinal-epidural anesthesia for cesarean section in singleton versus twin pregnancies. A randomized controlled trial was conducted, enrolling 200 pregnant women, 100 of which were of singleton pregnancies while the other 100 were of twin pregnancies, at West China Second University Hospital, Sichuan University between November 3, 2020 and June 2, 2021. All 200 subjects were to have Cesarean section under combined spinal-epidural anesthesia. By using a random number table, they were randomly assigned to five groups, receiving norepinephrine at the infusion dosage of 0.025, 0.050, 0.075, 0.100, and 0.125 μg/(kg·min), with 20 subjects of singleton pregnancy and 20 subjects of twin pregnancy in each group. Norepinephrine infusion started when the anesthesiologist initiated the spinal anesthetic injection and lasted until the delivery of the fetus. The primary outcome measure was the incidence of maternal hypotension during combined spinal-epidural anesthesia, up until the delivery of the fetus. Survival analysis, with survival being defined as not having hypotension, of the incidence of hypotension among the subjects was conducted. Probit regression was used to determine the ED 90 of norepinephrine, as well as the corresponding 95% confidence interval ( CI), for preventing hypotension during cesarean delivery under combined spinal-epidural anesthesia in women with singleton and twin pregnancies. There was no significant difference in the baseline data or the anesthesia and operation data between pregnant women of singleton pregnancy and those of twin pregnancy ( P>0.05). In singleton pregnant women receiving 0.025, 0.05, 0.075, 0.1 and 0.125 μg/(kg·min) of norepinephrine, the incidence of hypotension was 50% (10/20), 35% (7/20), 20% (4/20), 10% (2/20) and 5% (1/20), respectively. The estimated ED 90 of prophylactic norepinephrine for preventing hypotension during anesthesia was 0.100 (95% CI, 0.082-0.130) μg/(kg·min). In twin pregnant women receiving 0.025, 0.05, 0.075, 0.1 and 0.125 μg/(kg·min) of norepinephrine, the corresponding incidence of hypotension was 60% (12/20), 20% (4/20), 20% (4/20), 10% (2/20) and 5% (1/20). The estimated ED 90 of norepinephrine for preventing hypotension during anesthesia was 0.098 (95% CI, 0.080-0.127) μg/(kg·min). Survival analysis showed significant difference in the incidence of hypotension among the five groups receiving different infusion doses in singleton pregnancy subjects, and the same is true of the twin pregnancy subjects ( P<0.05). The incidence of reactive hypertension increased with increasing dosage of norepinephrine in both singleton pregnancy subjects and twin pregnancy subjects ( P<0.05). There was no significant difference in the incidence of other maternal adverse reaction or in neonatal outcomes in singleton and twin pregnancy subjects receiving different dosage of norepinephrine ( P>0.05). The gestational weeks, weight, and BMI were significantly different ( P<0.05), while the other characteristics, including age and height, were comparable ( P>0.05) between singleton and twin pregnancy subjects receiving norepinephrine at the same dosage. There was no significant difference in the incidence of hypotension, reactive hypertension, bradycardia, nausea and vomiting, and dizziness between singleton and twin pregnancy subjects receiving the same dose ( P>0.05). Survival analysis displayed no significant difference in the incidence of hypotension between singleton and twin pregnancy subjects receiving norepinephrine at the same dosage ( P>0.05). There was no significant difference in the ED 90 of norepinephrine between women with singleton pregnancies and those with twin pregnancies ( P>0.05). There was no significant difference in the ED 90 of norepinephrine for preventing hypotension during combined spinal-epidural anesthesia between women with singleton pregnancy and those with twin pregnancy. Interference of other factors, including gestational age, body mass, and BMI should be considered in clinical practice.

Effect of maternal body mass index on the prophylactic dose of phenylephrine for preventing hypotension in parturients after spinal anaesthesia

BackgroundTo compare the median effective dose (ED50) of phenylephrine for prophylactic continuous infusion in parturients with different body mass indices (BMIs) during combined spinal-epidural anaesthesia for caesarean section and to investigate the impact of maternal BMI on the prophylactic dose of phenylephrine. MethodsParturients receiving combined spinal-epidural anaesthesia for elective caesarean section were divided into a standard group (Group S, BMI < 30 kg/m2) and an obesity group (Group O, BMI > 30 kg/m2), each with 30 patients. A sequential allocation design was used to administer the prophylactic infusion of phenylephrine after the completion of a spinal anaesthetic injection to prevent hypotension (defined as a reduction of systolic blood pressure ≥ 20% of the baseline value or systolic blood pressure < 90 mmHg), with an initial infusion rate of 50 μg/min for the first parturient subsequent adjusted up or down by 10 μg/min depending on whether the previous parturient developed hypotension or not during the study period. The Dixon and Massey method and the isotonic regression method were used to calculate and compare the ED50 and 95% confidence interval (CI) of phenylephrine between the two groups. ResultsThe results were 21.92 μg/min (95% CI, 14.90–28.94 μg/min) for Group S and 42.14 μg/min (95% CI, 24.58–59.70 μg/min) for Group O. The ratio of relative potency of Group O to Group S is 1.92 (95% CI 1.09–3.14), P = 0.034. ConclusionsThe dose of phenylephrine for the prevention of hypotension after spinal anaesthesia for caesarean section is dependent on maternal BMI. Therefore, a weight-based phenylephrine dose is reasonable.

Recurrent Abducens Nerve Palsy, and Hypoglossus Nerve Palsy after Combined Spinal-Epidural Anesthesia for Cesarean Section

Recurrent Abducens Nerve Palsy, and Hypoglossus Nerve Palsy after Combined Spinal-Epidural Anesthesia for Cesarean Section

A randomized double-blind comparison of the double-space technique versus the single-space technique in combined spinal-epidural anesthesia for cesarean section

BackgroundCombined spinal-epidural anesthesia (CSEA) can be performed with either a single-space technique or a double-space technique for cesarean section. We performed a double-blind randomized controlled study to compare the effect of the double-space technique with that of the single-space technique on sensory block level and side effects.MethodsParturients undergoing elective cesarean section under regional anesthesia were randomized to receive CSEA with either the double-space technique (double group, n = 20) or the single-space technique (single group, n = 20). In the double group, an epidural catheter was inserted at the L1–2 interspace, and dural puncture was performed at the L3–4 interspace. In the single group, the procedure was performed at the L3–4 interspace using the needle-through-needle technique.ResultsThere were no differences in time to readiness or intraoperative level of sensory block between the two groups. The postoperative sensory level was maintained at a higher level in the double group than in the single group (1 h postoperatively, P = 0.029; 6 h postoperatively, P = 0.016). There was no difference between the two groups in terms of side effects. The parturient satisfaction scores 48 h postoperatively were significantly different between groups (9.5 in the double group vs. 8 in the single group, P = 0.004).ConclusionsWe conclude that there were no differences in intraoperative variables between the double-space technique and the single-space technique for CSEA. However, double-space CSEA for cesarean section may be beneficial for controlling postoperative pain and improving parturient satisfaction.Trial registrationThe study was retrospectively registered at https://cris.nih.go.kr under the trial ID KCT0002514. Date of registration: October 27, 2017.

A Combined Spinal-Epidural Anesthesia for Cesarean Section in a Pregnant Woman with a Ventriculoperitoneal Shunt

Combined Spinal Epidural Anesthesia for Cesarean Section in a Pregnant Woman with a Ventriculoperitoneal Shunt

Combined spinal-epidural anesthesia for cesarean section in a parturient with congenitally corrected transposition of the great arteries.

Combined spinal-epidural anesthesia for cesarean section in a parturient with congenitally corrected transposition of the great arteries.

Successful Management of Ultrasound-Guided Combined Spinal-Epidural Anesthesia for Cesarean Section in a Patient with Achondroplasia

Anesthetic management of the pregnant achondroplastic patient for cesarean section poses significant challenges for anesthetists when coupled with anesthetic risks encountered during the third trimester of pregnancy. We report the case of a 25-year-old, 107 cm in height, and 37-week woman with achondroplasia who underwent neuraxial anesthesia for an elective cesarean section. Due to lumbar hyperlordosis and tissue edema, spinous processes could not be palpated and ultrasound probe was used to identify the vertebral interspace and also, the distance to the ligamentum flavum was measured. Accompanied by combined spinal-epidural (CSE) set, epidural space was located and a spinal needle was placed to the subarachnoid space. After 5 mg 0.5% hyperbaric bupivacaine with 10 μg fentanyl (total volume 1.2 mL) was injected to the subarachnoid space, the epidural catheter was advanced. A bilateral T5 sensory block level to pinprick was obtained after 5 min and the operation was allowed. A baby girl weighing 2460 gr was delivered 7 min after skin incision. The patient felt pain and discomfort during the elevation of the uterus and 3 mL 2% lidocaine was injected twice at 5 min intervals via the epidural catheter. The patient had no complications related to her delivery or anesthetic and was discharged home on the second postoperative day. CSE anesthesia with low spinal dose and ability to increase the level of the block via epidural route when needed, in combination with ultrasound guidance, provided successful and safe anesthesia.

脳室腹腔シャント留置中の帝王切開に対する脊髄くも膜下硬膜外併用麻酔の経験

脳室腹腔シャント留置中の帝王切開に対する脊髄くも膜下硬膜外併用麻酔の経験

A Case report of combined spinal-epidural anesthesia for cesarean section in a patient with ventricular tachycardia

A Case report of combined spinal-epidural anesthesia for cesarean section in a patient with ventricular tachycardia

Acute intrathecal haematoma following neuraxial anaesthesia: diagnostic delay after apparently normal radiological imaging

We describe a case of intrathecal haematoma following combined spinal-epidural anaesthesia for caesarean section. The parturient was previously well with no risk factors for haematoma development. Surgical intervention was delayed, resulting in permanent neurological injury. Incorrect interpretation of clinical findings and magnetic resonance imaging contributed to the delay in definitive treatment. We discuss the difficulties in diagnosis, image interpretation and the need for a specialist opinion when abnormal neurological symptoms persist despite apparently normal imaging.

Combined spinal-epidural anesthesia for cesarean section in a patient with dilated cardiomyopathy

Combined spinal-epidural anesthesia for cesarean section in a patient with dilated cardiomyopathy

Trigeminal Nerve and Facial Nerve Palsy After Combined Spinal-Epidural Anesthesia for Cesarean Section

A case of emergency cesarean section due to a prolonged second stage of labor in a 29 year-old woman is presented. She had trigeminal nerve and facial nerve palsy after combined spinal-epidural anesthesia for cesarean section.

A Comparison of a Neuropen® Monofilament and Ethyl Chloride for Assessing Loss of Touch Sensation During Combined Spinal-Epidural Anaesthesia for Caesarean Section

A Comparison of a Neuropen® Monofilament and Ethyl Chloride for Assessing Loss of Touch Sensation During Combined Spinal-Epidural Anaesthesia for Caesarean Section

Ultra-low dose combined spinal-epidural anaesthesia for Caesarean section in severe pulmonary hypertension induced by Ritodrine

Ultra-low dose combined spinal-epidural anaesthesia for Caesarean section in severe pulmonary hypertension induced by Ritodrine

Trigeminal nerve and facial nerve palsy after combined spinal-epidural anesthesia for cesarean section

A case of emergency cesarean section due to a prolonged second stage of labor in a 29 year-old woman is presented. She had trigeminal nerve and facial nerve palsy after combined spinal-epidural anesthesia for cesarean section.

Combined spinal-epidural anesthesia for cesarean section in a patient with Moyamoya disease -A case report-.

Moyamoya disease is a rare progressive occlusive disease of the internal carotid arteries. We report a case of combined spinal-epidural anesthesia in a patient with Moyamoya disease presenting for Cesarean section. Hypotension associated with spinal anesthesia for Cesarean section is the most common and serious adverse effect despite the use of uterine displacement and volume preload. We continuously infused phenylephrine and ephedrine to prevent hypotension. The intraoperative hemodynamic state was stable. The patient had no significant postoperative complications.

Combined Spinal-Epidural Anaesthesia for Caesarean Section in a Patient with the Hyperadrenergic Sub

Combined Spinal-Epidural Anaesthesia for Caesarean Section in a Patient with the Hyperadrenergic Sub

The effect of different oxygen administration under combined spinal-epidural anesthesia for cesarean section.

During cesarean section under regional anesthesia, it is current practice to provide the parturient with a source of supplemental oxygen. We compared the effect of high flow oxygen by mask with that of low flow oxygen by nasal prongs. Fifty eight parturients presenting for elective cesarean section under combined spinal-epidural anesthesia were randomly assigned to one of the three groups to be given either oxygen 4 L/min by mask, oxygen 8 L/min by mask or oxygen 2 L/min by nasal prongs. Umbilical arterial and venous blood samples were taken and analysed immediately after delivery. There were no significant differences in the umbilical arterial or venous pH, partial pressure of oxygen and partial pressure of carbon dioxide among the three groups. In neonatal outcome, there were no differences in Apgar scores. It Makes No Differences Whether The Parturients Received Supplemental Oxygen By Nasal Prongs Or Simple Face Mask During Cesarean Section Under Combined Spinal-epidural Anesthesia.

Low-dose combined spinal-epidural anaesthesia for caesarean section in a patient with Eisenmenger’s syndrome

A 34-year-old woman (G3,P0) with Eisenmenger’s syndrome and positive HIV serology presented to hospital at 16 weeks of pregnancy. She was hospitalised at 20 weeks under the care of a multidisciplinary team. At 33 weeks caesarean section was performed under low-dose combined spinal-epidural anaesthesia using a needle-through-needle technique. Over a period of 10 min, spinal anaesthesia produced a sensory block to T4 which did not alter oxygenation or blood pressure. Epidural supplementation was not required. The caesarean section proceeded uneventfully without pain or discomfort. The post-partum period was without major incident. Low-dose combined spinal-epidural techniques combine the advantages of spinal and epidural blockade; the versatility allows its use in a wide range of clinical conditions, combining effective anaesthesia with cardiovascular stability.