[Motor and Sensory Blockade by Combined Spinal-Epidural Anesthesia for Cesarean Delivery]

We compared three combined spinal-epidural anesthesia (CSEA) techniques for cesarean delivery. Hypotension, nausea and vomiting are main problems produced by coonventional intrathecal doses. These problems were our secondary observations. Our primary observations were motor recovery and intraoperative pain.

Sixty patients were randomly allocated to one of the 3 groups (n = 20 per group). Group B (conventional dose): received intrathecally 0.5% hyperbaric bupivacaine (10 mg; < 160 cm in height 11 mg ; ≥ 160 cm in height) and epidural catheter at T12-L1. Group F (low-dose and addition of fentanyl) : received intrathecally 0.5% hyperbaric bupivacaine (70% of group B) with fentanyl 20 mg and epidural catheter at T12-L1. Group E (low-dose and epidural volume extension : EVE) : received intrathecally 0.5% hyperbaric bupivacaine (70% of group B) and epidural catheter at L3-4, through which 10 ml saline was injected 3 minutes after intrathecal injection.

Group F and E demonstrated faster motor recovery than group B. More patients in group E than those in group B and F complained of intraoperative pain. There was no incidence of hypotension, nausea and vomiting.

Group F and group E demonstrated similar fast motor recovery, but the former caused less intraoperative pain than the latter. Because this is an observational study, comparison of techniques such as addition of fentanyl, EVE, needs a compatative study.