Epidural versus combined spinal epidural block for cesarean section

In a controlled study a single segment combined spinal epidural (CSE) block was compared with epidural block for cesarean section. Thirty healthy parturients were randomly divided into two groups. In both groups a T4 block was aimed at. Bupivacaine was used to provide analgesia in both groups. All patients receiving CSE block had good to excellent analgesia, while 11 patients (74%) receiving epidural block had similar pain relief. This was reflected in the requirement for additional analgesics, sedatives or N2O anesthesia. The muscular relaxation was also better following CSE block. The total dose of bupivacaine for a T4 block was three times larger in patients receiving only epidural block. The maternal and fetal blood bupivacaine levels were correspondingly about three times higher in the epidural group. Additionally, the incidence of maternal hypotension was higher in patients receiving epidural block. Apgar scores, blood gases and neurobehavioural evaluation did not show any differences between the two groups of neonates. No postspinal headache was noted. CSE block appears to combine the reliability of spinal block and the flexibility of epidural block while minimizing their drawbacks.