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Combined spinal-epidural versus spinal anaesthesia for caesarean section
Scott W Simmons1, Alicia T Dennis, Allan M Cyna
1Department of Anaesthesia, Mercy Hospital for Women, 163 Studley Road, Heidelberg, Victoria, Australia, 3084.
The Cochrane Database of Systematic Reviews
|October 11, 2019
Summary
Combined spinal-epidural (CSE) anesthesia may reduce hypotension during C-sections but increase nausea compared to single-shot spinal anesthesia (SSS). Insufficient evidence exists to favor one technique, necessitating further high-quality research.
Area of Science:
- Anesthesiology
- Obstetric Anesthesia
- Regional Anesthesia
Background:
- Single-shot spinal anesthesia (SSS) and combined spinal-epidural (CSE) anesthesia are common for cesarean sections.
- Spinal anesthesia offers rapid onset but may cause hypotension; CSE allows gradual onset and prolonged anesthesia via catheter.
Purpose of the Study:
- To compare the effectiveness and adverse effects of CSE anesthesia versus SSS for cesarean section.
Main Methods:
- Searched multiple trial registers for randomized controlled trials (RCTs) comparing CSE with SSS for cesarean section.
- Included 18 RCTs with 1272 women; analyzed outcomes for CSE versus high-dose spinal and CSE versus low-dose spinal anesthesia.
- Assessed risk of bias and extracted data independently.
Main Results:
- CSE may offer little difference in repeat blocks or general anesthesia compared to high-dose spinal, but evidence quality is low.
- CSE might reduce intra-operative hypotension versus low-dose spinal, but may increase nausea/vomiting; evidence quality varies.
- Low-dose spinal may provide faster anesthesia onset than CSE, but the difference is likely not clinically meaningful.
Conclusions:
- Limited data and study design limitations exist for most outcomes.
- Insufficient evidence supports one technique over the other for cesarean section anesthesia.
- More high-quality, adequately powered studies are needed to evaluate CSE and SSS effectiveness and safety.
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