Regional anaesthesia for caesarean section in severe preeclampsia: spinal anaesthesia is the preferred choice

Standard textbooks advocate epidural rather than spinal anaesthesia for caesarean section in severe preeclampsia. The basis for this recommendation is the theoretical risk of severe hypotension but no published scientific studies have been identified to support this assertion. We therefore designed a prospective study to compare spinal versus epidural anaesthesia in severely pre-eclamptic patients requiring hypotensive therapy. Following ethics committee approval, 28 women with preeclampsia requiring hypotensive medication who were scheduled for urgent (not emergency) or elective caesarean section consented to receive epidural or spinal anaesthesia by random assignment. Seven patients were excluded due to protocol violations. Four of these were in the epidural group of which two were excluded due to inadequate analgesia. No spinal patient was excluded because of inadequate analgesia. Mean ephedrine dosage was 5.2 mg (range 0-24 mg) in the spinal group and 6.3 mg (range 0-27 mg) in the epidural group. Six of the 11 patients in the spinal group required no ephedrine as did five of 10 in the epidural group. One patient in the spinal group suffered from mild intraoperative pain. By contrast in the epidural group three patients had mild pain and four others had pain severe enough to warrant intraoperative analgesia. There were no differences in neonatal outcomes. These findings support recent studies suggesting the safety and efficacy of spinal anaesthesia in this group of patients.