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Extending epidural analgesia for emergency Caesarean section: a meta-analysis
S G Hillyard1, T E Bate, T B Corcoran
1Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, WA 6847, Australia. sghillyard@yahoo.co.uk
British Journal of Anaesthesia
|October 15, 2011
Summary
For emergency Cesarean sections, lidocaine and epinephrine epidural solutions offer rapid onset. Bupivacaine or levobupivacaine 0.5% is least effective, while 0.75% ropivacaine ensures higher block quality.
Area of Science:
- Anesthesiology
- Obstetric Anesthesia
- Pharmacology
Background:
- Optimal epidural solutions for converting labor analgesia to surgical anesthesia for Cesarean sections lack high-level evidence.
- Emergency Cesarean sections require rapid and effective anesthetic conversion.
Purpose of the Study:
- To identify the best epidural solutions for emergency Cesarean section anesthesia.
- To compare solutions based on speed of onset and need for intraoperative supplementation.
Main Methods:
- Systematic literature search and risk of bias assessment of eleven randomized controlled trials (779 parturients).
- Meta-analysis using fixed-effects model to compare 'top-up' boluses: 0.5% bupivacaine/levobupivacaine (Bup/Levo), lidocaine and epinephrine ± fentanyl (LE ± F), and 0.75% ropivacaine (Ropi).
Main Results:
- Lidocaine and epinephrine (LE ± F) demonstrated significantly faster sensory block onset (MD -4.51 min, P < 0.00001).
- Bupivacaine/levobupivacaine 0.5% (Bup/Levo) showed increased need for intraoperative supplementation (RR 2.03, P = 0.007) compared to other groups.
- 0.75% ropivacaine was suggested for superior block quality.
Conclusions:
- Lidocaine and epinephrine solutions are optimal when rapid onset is critical for emergency Cesarean sections.
- 0.75% ropivacaine is recommended if the quality of the epidural block is the primary concern.
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