Comparing epidural surgical anesthesia and spinal anesthesia following epidural labor analgesia for intrapartum cesarean section: a prospective randomized controlled trial.
10.4097/kjae.2017.70.4.412
- Author:
Hea Jo YOON
1
;
Sang Hwan DO
;
Yeo Jin YUN
Author Information
1. Department of Anesthesiology and Pain Medicine, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea. heajo7890@hanmail.net
- Publication Type:Randomized Controlled Trial ; Original Article
- Keywords:
Cesarean section;
Epidural anesthesia;
Epidural labor analgesia;
Spinal anesthesia
- MeSH:
Analgesia*;
Anesthesia*;
Anesthesia, Epidural;
Anesthesia, General;
Anesthesia, Spinal*;
Bupivacaine;
Cesarean Section*;
Epinephrine;
Female;
Fentanyl;
Hypotension;
Incidence;
Labor Pain;
Lidocaine;
Nausea;
Pregnancy;
Prospective Studies*;
Shivering;
Vomiting
- From:Korean Journal of Anesthesiology
2017;70(4):412-419
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: The conversion of epidural labor analgesia (ELA) to epidural surgical anesthesia (ESA) for intrapartum cesarean section (CS) often fails, resulting in intraoperative pain. Spinal anesthesia (SA) can provide a denser sensory block than ESA. The purpose of this prospective, non-blinded, parallel-arm, randomized trial was to compare the rate of pain-free surgery between ESA and SA following ELA for intrapartum CS. METHODS: Both groups received continuous epidural infusions for labor pain at a rate of 10 ml/h. In the ESA group (n = 163), ESA was performed with 17 ml of 2% lidocaine mixed with 100 µg fentanyl, 1 : 200,000 epinephrine, and 2 mEq bicarbonate. In the SA group (n = 160), SA was induced with 10 mg of 0.5% hyperbaric bupivacaine and 15 µg fentanyl. We investigated the failure rate of achieving pain-free surgery and the incidence of complications between the two groups. RESULTS: The failure rate of achieving pain-free surgery was higher in the ESA group than the SA group (15.3% vs. 2.5%, P < 0.001). There was no statistical difference between the two groups in the rate of conversion to general anesthesia; however, the rate of analgesic requirement was higher in the ESA group than in the SA group (12.9% vs. 1.3%, P < 0.001). The incidence of high block, nausea, vomiting, hypotension, and shivering and Apgar scores were comparable between the two groups. CONCLUSIONS: SA after ELA can lower the failure rate of pain-free surgery during intrapartum CS compared to ESA after ELA.
