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KMID : 0356920170700040412
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Korean Journal of Anesthesiology
2017 Volume.70 No. 4 p.412 ~ p.419
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Comparing epidural surgical anesthesia and spinal anesthesia following epidural labor analgesia for intrapartum cesarean section: a prospective randomized controlled trial
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Yoon Hea-Jo
Do Sang-Hwan
Yun Yeo-Jin
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Abstract
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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.
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KEYWORD
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Cesarean section, Epidural anesthesia, Epidural labor analgesia, Spinal anesthesia
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