Combined spinal-epidural vs. spinal anaesthesia for caesarean section: meta-analysis and trial-sequential analysis

Area of Science:

• Anesthesiology
• Obstetric Anesthesia

Background:

• Combined spinal-epidural (CSE) and single-shot spinal anesthesia (SSA) are utilized for cesarean sections.
• Previous trials suggested CSE may provide superior sensory block spread and cardiovascular stability.

Purpose of the Study:

• To systematically evaluate and compare the efficacy and safety of CSE versus SSA for cesarean delivery.
• To synthesize existing evidence through meta-analysis and assess the quality of available data.

Main Methods:

• Conducted a systematic literature search to identify relevant randomized controlled trials.
• Performed conventional meta-analysis, trial-sequential analysis, and quality assessment using the GRADE system.
• Analyzed data from 15 trials involving 1015 patients, assessing primary and secondary outcomes.

Main Results:

• No significant differences were found between CSE and SSA for maximum sensory block height or vasopressor requirements.
• Trial-sequential analysis indicated insufficient data for primary outcomes, with GRADE scores revealing 'very low' evidence quality.
• Secondary outcomes, including hypotension, block regression time, and nausea/vomiting, also showed no significant differences.

Conclusions:

• Current evidence does not support a significant advantage of CSE over SSA for cesarean sections.
• The quality of evidence for key outcomes is low, highlighting the need for more robust research.
• Future studies should investigate potential benefits of CSE, particularly when utilizing the epidural route intraoperatively or postoperatively.